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Little is known about the underlying neurobiological mechanisms in patients with obsessive-compulsive disorder (OCD). We aimed to examine cortical thickness and surface area in individuals with OCD and their unaffected siblings, comparing them to healthy controls. 30 patients with OCD, 21 unaffected siblings (SIB) and 30 controls underwent structural magnetic resonance imaging. Structural images were analyzed using the FreeSurfer software package (version 6.0). Compared to healthy controls, both OCD and SIB groups showed significantly lower cortical thickness in the right anterior insula. Surface areas of the superior frontal gyrus, paracentral gyrus and precuneus of the right hemisphere were also reduced in OCD patients compared to controls. There were no significant differences in cortical thickness and surface area between the OCD and SIB groups. We did not detect any significant differences in subcortical volumes between groups. Lower cortical thickness in the right anterior insula in both OCD patients and unaffected siblings may represent a potential structural endophenotype for OCD.

Objective We aimed to examine white matter microstructure and connectivity in individuals with obsessive-compulsive disorder (OCD) and their unaffected siblings, relative to healthy controls. Methods Diffusion-weighted magnetic resonance imaging (dMRI) scans were acquired in 30 patients with OCD, 21 unaffected siblings, and 31 controls. We examined white matter microstructure using measures of fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). Structural networks were examined using network-based statistic (NBS). Results Compared to controls, OCD patients showed significantly reduced FA and increased RD in clusters traversing the left forceps minor, inferior fronto-occipital fasciculus, anterior thalamic radiation, and cingulum. Furthermore, the OCD group displayed significantly weaker connectivity (quantified by the streamline count) compared to controls in the right hemisphere, most notably in edges connecting subcortical structures to temporo-occipital cortical regions. The sibling group showed intermediate streamline counts, FA and RD values between OCD and healthy control groups in connections found to be abnormal in patients with OCD. However, these reductions did not significantly differ compared to controls. Conclusion Therefore, siblings of OCD patients display intermediate levels in dMRI measures of microstructure and connectivity, suggesting white matter abnormalities might be related to the familial predisposition for OCD.

We aimed to examine the whole-brain white matter connectivity and local topology of reward system nodes in patients with alcohol use disorder (AUD) and unaffected siblings, relative to healthy comparison individuals. Diffusion-weighted magnetic resonance imaging scans were acquired from 18 patients with AUD, 15 unaffected siblings of AUD patients and 15 healthy controls. Structural networks were examined using network-based statistic and connectomic analysis. Connectomic analysis showed a significant ordered difference in normalized rich club organization (AUD Sibling > AUD) for both nodal clustering coefficient and nodal local efficiency in reward system nodes, particularly left caudate, right putamen and left hippocampus. Network-based statistic analyses showed that AUD group had significantly weaker connectivity than controls in the right hemisphere, mostly in the edges connecting putamen and hippocampus with other brain regions. Our results suggest that reward system network abnormalities, especially in subcortical structures, and impairments in rich-club organization might be related to the familial predisposition for AUD.

Clinical correlates of obsessive-compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive-Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive-compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group. As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS. This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD.

OBJECTIVE Little is known about the relationship between antidepressant treatment outcomes and underlying neurobiological mechanisms in patients with major depressive disorder (MDD). In this prospective study, we aimed to investigate how cortical thickness and subcortical volumes differed between remitter and non-remitter patients with MDD. METHODS Fifty-eight patients with MDD with a score of at least 17 on the 17-item Hamilton Depression Rating Scale and free of medication for at least 2 months and 41 healthy controls underwent structural magnetic resonance imaging. At the baseline, patients with MDD started on either selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or vortioxetine. After 8-week antidepressant treatment, patients with MDD were scanned using the same MRI protocol. Structural images were analyzed using the FreeSurfer software package (version 6.0). RESULTS Longitudinal analyses showed remitter patients with MDD had significantly greater right cerebral cortex thickening in six significant clusters, including superior temporal cortex, precuneus, rostral middle frontal cortex, pars opercularis (although the cluster extends into the insula), inferior parietal cortex, and supramarginal cortex than in non-remitter patients with MDD. CONCLUSION Our results suggest that distinct antidepressant treatment-related structural alterations in brain regions implicated in cognition, emotion regulation, and rumination might be associated with treatment outcome.

WOS: 000368752800003, PubMed ID: 26773986, Background: Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising scale for assessing frequency and severity of symptom dimensions. The main objective of the study was to assess the psychometric properties of the DY-BOCS in a large sample of children and adolescents from Turkey. Methods: We studied 143 children and adolescents, 7-18 years, with well characterized DSM-IV-R OCD, ascertained from seven collaborating university or state hospital sites. We compared the DY-BOCS scores with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Children's Depression Inventory (CDI), the Yale Global Tic Severity Scale (YGTSS) and the Child Behavior Checklist 6-18 years (CBCL 6-18). Results: The internal consistency of the DY-BOCS symptom dimensions and inter-rater agreement of component scores were excellent. The agreement between global DY-BOCS score and the total CY-BOCS score was highly significant (Pearson's r = 0.55, p < 0.0001). Severity scores for individual symptom dimensions were independent of one another, only modestly correlating with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. Conclusion: The DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in children and adolescents from Turkey. (C) 2015 Elsevier Inc. All rights reserved., Fogarty/NIH ICOHRTA [5D43TW005807]; NIH/Fogarty International Center MHDD Research Training Program at the Boston Children's Hospital, Division of Developmental Medicine, Harvard Medical School [5D43TW005807], The research was funded in part by Fogarty/NIH ICOHRTA grant 5D43TW005807 and Dr. AS Guler was supported by the NIH/Fogarty International Center MHDD Research Training Program (5D43TW005807, PI, Dr. K. Munir) at the Boston Children's Hospital, Division of Developmental Medicine, Harvard Medical School.

Background and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one's life story. One reason a traumatic memory becomes a reference point for one's life story is that it brings about significant changes in one's life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity. Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI). Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.

A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.

Synthetic cannabinoids have become increasingly popular in the last few years especially among adolescents and young adults. However, no previous studies have assessed the effects of synthetic cannabinoids on the structure of the human brain. Understanding the harms of synthetic cannabinoid use on brain structure is therefore crucial given its increasing use. Diffusion tensor imaging (DTI) was performed in 22 patients who used synthetic cannabinoids more than five times a week for at least 1 year and 18 healthy controls. Fractional anisotropy (FA) was significantly reduced in the cannabinoid group compared to controls in a cluster of white matter voxels spanning the left temporal lobe, subcortical structures and brainstem. This cluster was predominantly traversed by the inferior frontooccipital fasciculus, inferior longitudinal fasciculus, fornix, cingulum-hippocampus and corticospinal tracts. Long-term use of synthetic cannabinoids is associated with white matter abnormalities in adolescents and young adults. Disturbed brain connectivity in synthetic cannabinoid users may underlie cognitive impairment and vulnerability to psychosis. (C) 2016 Elsevier B.V. and ECNP. All rights reserved.

Cognitive-behavioral therapies (CBT), antidepressants and neuromodulation techniques are current treatment options used in various stages of treatment procedure for obsessive-compulsive disorder (OCD). The factors that disparate treatment options from psychological approaches to invasive surgical techniques in a psychiatric disorder have in common have scarcely been described in the relevant literature. Cognitive neuropsychological model (CNM) as a novel approach offers a common framework in which psychological and neurobiological models of different psychopathologies are reconciled by means of impaired emotional processing. In this paper, an integrated approach of disrupted top-down and bottom-up emotional processing has been described to understand the efficacy of the different treatment modalities for OCD. In this model, the cognitive therapy is proposed to contribute to the gradual breakdown of schemata through the effect on top-down emotional processing instead of acting on information processing biases directly. Antidepressant drugs and behavioral therapy are proposed to alter the brain's emotion processing in a bottom-up process. Resistance to pharmacotherapy and CBT is a common problem in the patients with OCD, and a lot of factors have been described as negative predictors of these treatment options. The severity of symptoms, presence of specific symptoms, poorer insight, high level of dissociation and family accommodation are the factors associated with resistance to both pharmacotherapy and CBT. The underlying reasons establishing an association between the presence of these diverse factors and treatment resistance were discussed in the context of CNM.

Objective. Seasonality is one of the most interesting but still elusive issue in suicide research. Linkages of seasonality in suicides to possible contributors such as gender, type of method used, and climatic factors have received attention in different cultures. We aimed at evaluating seasonal trends in suicidal behaviour according to demographic characteristics, reasons for self-destructive behaviour and means preferred in suicide. Methods. Our aim was to assess the seasonal variation in self-destructive behaviour in terms of completed and attempted suicides in a 3-year time period from 2008 to 2010 in Van, Turkey. A total of 1448 cases were registered over a 3-year time period in the city. Seasonal deviations in demographic characteristics, reasons for suicide, and methods of suicide were evaluated. Results. Seasonal distribution of both completed and attempted suicides by gender did not significantly deviate. On the other hand, we found a significant decline in self-destructive behaviours among those who were single and student in the spring. We found a peak in self-destructive behaviours in the autumn among Individuals who suffer from psychological problems. Conclusions. Subjects with psychological difficulties were more prone to commit suicide in autumn. Seasonal differences in methods of suicide used by suicidal subjects were not significant.

The predictive value of interpersonal schemas, perfectionism, and thought action-fusion in obsessive-compulsive disorder Objective: Cognitive vulnerability factors are central in the etiology of obsessive-compulsive disorder. Nosological classifications among symptom clusters have been developed to enable the understanding of possible mechanisms underlying obsessive compulsive symptoms. Previous researchers have emphasized that perfectionist attitudes and thought action-fusion link to increase in obsessive compulsive symptom severity in clinical and nonclinical samples. However, multi-dimensional relations between obsessive compulsive symptoms and vulnerability factors such as interpersonal schemas have received little attention. This study examined connections between cognitive vulnerability factors and obsessive-compulsive symptoms. Method: The data collected from 263 university students. Associations between variables were analyzed by using structural equation modeling. Results: The results of the study indicated that dysfunctional interpersonal schemas were the most hazardous factors that predict perfectionist attitudes, thought action-fusion, and symptom severity in obsessive compulsive disorder. Washing and precision were the final manifestation symptoms mediated by checking. Maladaptive interpersonal schemas, perfectionist attitudes, and thought action-fusion were all vulnerability agents in the development of obsessive compulsive symptoms. Checking played a prominent role in exacerbation of obsessive –compulsive symptoms. Conclusion: Onset and maintenance of obsessive-compulsive disorder is a multidimensional process. Negativistic interpersonal beliefs seem to be an important risk factor. Findings are discussed in the light of current theoretical considerations.

Human studies suggest that free radicals and antioxidant enzymes can alter according to age, lifestyle, environment, and habits. Individuals having a marked circadian preference, that is, morning type or evening type, differ on a number of psychological, behavioral, and biological variables. The aim of this study was to determine whether chronotype impacts some parameters of oxidant and antioxidant status. For this purpose, glutathione peroxidase (GSH-P-x), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities and the levels of reduced glutathione (GSH) and malondialdehyde (MDA) were measured in 96 healthy volunteers (including 32 morning-type, 32 intermediate-type, and 32 evening-type individuals), aged between 21 and 26 years. There were no significant relationships between the chronotypes with regard to oxidant and antioxidant parameters. Our results indicated that the levels of GSH and MDA as well as the activities of GSH-P-x, MPO, and SOD were not influenced by the individual circadian differences in our sample. These results were discussed using the theoretical concepts of age-related factors, and suggestions for further research presented. Human studies suggest that free radicals and antioxidant enzymes can alter according to age, lifestyle, environment, and habits. Individuals having a marked circadian preference, that is, morning type or evening type, differ on a number of psychological, behavioral, and biological variables. The aim of this study was to determine whether chronotype impacts some parameters of oxidant and antioxidant status. For this purpose, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities and the levels of reduced glutathione (GSH) and malondialdehyde (MDA) were measured in 96 healthy volunteers (including 32 morning-type, 32 intermediate-type, and 32 evening-type individuals), aged between 21 and 26 years. There were no significant relationships between the chronotypes with regard to oxidant and antioxidant parameters. Our results indicated that the levels of GSH and MDA as well as the activities of GSH-Px, MPO, and SOD were not influenced by the individual circadian differences in our sample. These results were discussed using the theoretical concepts of age-related factors, and suggestions for further research presented.

Background Many patients who remit fully/partially or recover from an episode of major depression continue to suffer from sleep problems, mainly insomnia. Our study assesses the frequency and types of ongoing or re-emerging subjective insomnia symptoms and their relationship to subsequent depressive relapse or recurrence in a group of full/partial remitters or recoverers. Method Sixty patients, 18 to 65 years of age, with current MDD defined using DSM-IV-TR criteria were participated in the study. They began a 24-week course of open-label acute plus continuation phase treatment mainly with SSRIs. Maintenance treatment was not planned for not affecting natural relapse or recurrence rates. All participants were evaluated by CGI-S, BDI, HAMD-17, PSQI, and ISI at weeks 0, 4, 12, 24, and 52. Results Majority of the participants (83.33%) had subjective sleep disturbance, insomnia prior to relapse or recurrence. Repeated measures ANOVA was used to evaluate changes in scores of depression and sleep scales over time between recurred (N = 12) and non-recurred groups (N = 48). Differences between means were calculated with post hoc Bonferroni comparison test. The changes in scores of entire clinical scales over time between recurred and non-recurred groups were statistically significant. Limitations The limitations of this study include the use of a relatively small, mostly young female sample and the lack of an objective sleep measure to corroborate self-report scales. Conclusions Early recognition and treatment of disturbances of the sleep–wake cycle may be important for treatment and prevention of recurrence of depression.

Objective: The aim of the present study was to investigate the relationship between nightmares and acute myocardial infarction (AMI) occurring during sleep, and also to evaluate the influence of several related factors. Method: The sample comprised AMI patients who had been admitted to the coronary care unit. The patients were grouped into two categories; the asleep-AMI group consisted of 36 patients who had the onset of symptoms of AMI during sleep, and the awake-AMI group included 183 patients who had AMI while they were awake. The sleep quality and dream anxiety for the 1-month interval before AMI were assessed with Pittsburgh Sleep Quality Index (PSQI) and Van Dream Anxiety Scale (VDAS), respectively. Results: Asleep-AMI patients reported significantly poorer subjective sleep quality, significantly higher global PSQI scores, and displayed significantly higher nightmare frequency, difficulty in falling asleep after a nightmare, higher autonomic hyperactivity, dream recall frequency, daytime anxiety, psychological problems, and higher global dream anxiety scores than awake-AMI patients. Conclusion: The present study suggests that sleep anxiety and related emotions are associated with AMI during sleep. (Psychosomatics 2011; 52:544-549)

Morning and evening-type individuals differ on a number of psychological and biological variables. In this study, we aimed to investigate the relationship between sleep quality, dream anxiety, and chronotypes. A sample of 264 university students, aged between 17 and 26 years, completed the Morningness-Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, and the Van Dream Anxiety Scale for assessing nightmare frequency and the dream anxiety caused by frightening dreams. Main findings indicated that evening-type individuals were significantly more likely to suffer from poor sleep quality, daytime dysfunction, nightmares, and nightmare-related disturbances as compared to either intermediate- or morning-type individuals. Previous studies have pointed out the possible connections of irregular sleep-wake habits and circadian dysregulation with a tendency to reveal eveningness chronotypical characteristics. Current findings suggest that evening-type individuals are more prone to experience psychologically deteriorating nightmares and sleep-related anxiety. Poor sleep quality is also a significant antecedent of dream anxiety after controlling for age and gender.

Besiroglu L, Sozen M, Ozbebit O, Avcu S, Selvi Y, Bora A, Atli A, Unal O, Bulut MD. The involvement of distinct neural systems in patients with obsessive–compulsive disorder (OCD) with autogenous and reactive obsessions. Objective: To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. Method: We assessed right anterior cingulate cortex (ACC) and amygdala–hippocampal region (Am + Hpp) N-acetyl-aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single-voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD-A), 15 patients with reactive obsessions (OCD-R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. Results: Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD-A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD-A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. Conclusion: While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.

Population-based studies indicate the risk of acute myocardial infarction (AMI) is greatest in the morning, during the initial hours of diurnal activity. The aim of this pilot study was to determine whether chronotype, i.e., morningness and eveningness, impacts AMI onset time. The sample comprised 63 morning- and 40 evening-type patients who were classified by the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) in the hospital after experiencing the AMI. The average wake-up and bed times of morning types were similar to 2 h earlier than evening types. Although the lag in time between waking up from nighttime sleep and AMI onset during the day did not differ between the two chronotypes, the actual clock-hour time of the peak in the 24-h AMI pattern did. The peak in AMI of morning types occurred between 06:01 and 12:00 h and that of the evening types between 12:01 and 18:00 h. Although the results of this small sample pilot study suggest one's chronotype influences the clock time of AMI onset, larger scale studies, which also include assessment of 24-h patterning of events in neither types, must be conducted before concluding the potential influence of chronotype on the timing of AMI onset. (Author correspondence: dryavuzselvi@yahoo.com).

Objective. The present study examined whether obsessive beliefs change over time in the OCD patients receiving selective serotonin reuptake inhibitors (SSRIs) and the impact of obsessive beliefs in treatment response. Methods. In the first part of a two-stage study comparing the efficacy of antipsychotics as augmenting agent in SSRI-resistant OCD patients, 57 patients were interviewed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and Obsessive Beliefs Questionnaire-44 (OBQ-44) before and after 12-week of SSRI treatment period. Results. All OBQ-44 subscale scores significantly decreased with SSRI treatment. The mean changes in OBQ-44 Importance and Control of Intrusive Thoughts (I/CT) subscale and HDRS total scores of responders were significantly higher than those of SSRI-resistant patients. The baseline OBQ-44 P/C and Y-BOCS obsession subscale scores significantly predicted the treatment resistance in a logistic regression model. Conclusions. The alleviation of negative mood by SSRIs may help the sufferer to disengage from dysfunctional appraisals. Since individuals with highly obsessive beliefs about P/C are more likely to be resistant to SSRI treatment, the treatment of OCD can be made more effective when focusing on altering appraisals about P/C.

Morning- and evening-type individuals differ on a number of psychological and biological variables. There has been increasing interest in the relationship between chronotype and personality traits. The aim of this study was to investigate the relationship between impulsivity and chronotype in suicide attempters. Eighty-nine suicide attempters were included in the study, and systematic information on suicide attempts was recorded. The Morningness-Eveningness Questionnaire was applied to determine chronotype, and attempter impulsivity was measured by the total score of the Barratt Impulsiveness Scale. Significant differences between chronotype and impulsivity scores were found. Evening-type subjects reported significantly higher impulsivity scores than both neither- and morning-types. A significant association between chronotype and type of suicide attempt was detected. The largest proportion of violent suicide attempters were evening-type subjects. Violent suicide attempters also reported significantly higher impulsivity scores than nonviolent attempters. Previous studies have pointed out possible relations between eveningness and impulsivity. Current findings suggest that eveningness may be a risk factor for violent suicide attempts by increasing impulsivity. (Author correspondence: dryavuzselvi@yahoo.com).

Objective: This study aimed to assess the symptoms of psychopathology caused by the shift-work and to evaluate their impact on the quality of life. Method: Forty-two nurses working at daytime and 45 nurses working at the night shift were evaluated with Symptom Checklist-90-R (SCL-90-R) and Short Form 36 (SF-36) for assessing general psychiatric symptoms and quality of life. Results: Shift-work nurses reported significantly higher somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, paranoid ideation and global severity index scores than daytime nurses. Significant differences were not found in the depression, hostility, phobic anxiety and psychoticism scores. Shift-work nurses also reported significantly worse scores on pain and physical function compared with daytime nurses. Conclusion: In our study, shift-work was shown to be a potential risk factor for increased psychiatric morbidity and low quality of life among nurses. Therefore, adjusting the work schedule with the potential problems of the workers may improve their life quality.

Research interest concerning associations between sleep characteristics and suicidality in psychopathology has been growing. However, possible linkages of suicidality to sleep characteristics in terms of sleep quality and chronotypes among depressive patients have not been well documented. In the current study, the authors investigated the possible effects of sleep quality and chronotype on the severity of depressive symptoms and suicide risk in patients with depressive disorder and healthy controls. The study was conducted on 80 patients clinically diagnosed with major depression and 80 healthy subjects who were demographically matched with the patient group. All participants completed a questionnaire package containing self-report measures, including the Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), and Suicide Ideation Scale (SIS), and subjects were interviewed with the suicidality section of the Mini-International Neuropsychiatric Interview (MINI). Results are as follows: (a) logistic regression analyses revealed that poor sleep quality and depression symptom severity significantly predicted onset of major depression; (b) morningness-type circadian rhythm may play as a significant relief factor after onset of major depression; (c) sleep variables of chronotype and sleep quality did not significantly predict suicide ideation after controlling for depressive symptoms in the major depression group; and (d) suicide ideation and poor sleep quality were antecedents of depression symptom severity in patients with major depression, and in healthy controls. Findings are discussed under the theoretical assumptions concerning possible relations between chronotype, sleep quality, depression, and suicidality. (Author correspondence: dryavuzselvi@yahoo.com).

In this study, patients with what were considered 'psychosomatic' skin diseases were compared with patients with skin conditions that are thought to be 'non-psychosomatic' diseases in terms of their reported history of childhood traumatic experiences, dissociative experiences and thought suppression. Ninety-six patients with 'psychosomatic' skin disease were included in the study. The comparison subjects (n = 54) were patients with skin conditions believed to have a negligible psychosomatic component and the subjects without skin disease (n = 77). Subjects were administered with the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES) and the White Bear Suppression Inventory (WBSI). While the 'emotional neglect' scores of the psychosomatic' group were significantly higher than that of both 'non-psychosomatic' and healthy subjects, there were no significant differences for the other subscales of the CTQ. The 'psychosomatic' group scored significantly higher on the DES absorption scale, DES total and WBSI scores than the other groups. Significantly more patients in the 'psychosomatic' group reported a stressful life event as related to the onset of skin complaints compared with the 'non-psychosomatic' group. Our results suggest that the effect of subjective perception of emotional neglect, mediated by stressful life events, increases the vulnerability to psychosomatic disease. Copyright (C) 2008 John Wiley & Sons, Ltd.

Twenty-eight subjects with and 46 subjects without sleep-related violence (VBS) were evaluated regarding the presence of self-mutilative behaviors (SMBs). The subjects with and without VBS were compared using dissociative experiences scale (DES). The subjects with VBS had higher mean DES score and more frequent SMBs than those without VBS. These findings suggest that dissociation may be related to both daytime SMBs and violent behaviors during sleep in young population.

INTRODUCTION Although putative subtypes of obsessive-compulsive disorder (OCD) have been gradually more recognized, there is no generally accepted subtype discrimination. It has been suggested that autogenous and reactive obsessions stem from different cognitive process. This study aimed to assess existence of gender, age at onset of illness, and comorbidity differences in OCD patients suffering from autogenous and reactive obsessions. METHODS The medical records of 177 OCD patients were evaluated retrospectively for gender, age at onset, comorbid diagnoses, and predisposing life events. Obsessions and compulsions were coded according to the Yale-Brown Obsessive-Compulsive Scale. All patients were grouped as the patients with autogenous (autogenous group [AG] n=32), reactive (reactive group [RG] n=77) and mixed obsessions (mixed group [MG] n=68). RESULTS AG patients were significantly more likely to be male, compared with the RG and MG patients. They also had significantly later onset of illness. Dissociative disorders were less common among AG patients compared with the other groups. CONCLUSION Results suggest that the discrimination between autogenous and reactive obsessions are not only based on their development and maintenance mechanism through different cognitive process but that there also clinical manifestations of this discrimination.

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non-health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, 'insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly worse levels of QOL in psychological health and level of independence domains. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals' ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD. (C) 2004 Elsevier Inc. All rights reserved.

Introduction: The current article addresses the validation of the construct of obsessional probabilistic inference in clinical and non-clinical samples. Obsessional probabilistic inference or obsessional doubt refers to a type of inferential process resulting in the belief that a state of affairs “maybe” causes development of a maladaptive cognitive coping style in terms of obsessing. Methods: The latent structure of the Obsessional Probabilistic Inference Scale (OPIS) was evaluated with confirmatory factor analysis. Results: Explanatory and confirmatory factor analyses indicated that a one-factor solution was satisfactory for the instrument, assessing a unidimensional psychological construct. The OPIS was shown to have high internal consistency in all samples, as well as temporal stability, relying on predominantly non-clinical individuals. The scale exhibited high convergent validity and successfully discriminated patients with obsessive-compulsive disorder from both depressive patients and controls. Conclusion: The findings replicated and extended the role of reasoning process in the development and maintenance of obsessive compulsive symptoms. The results are discussed in regard to assumptions of the inference-based approach to obsessive-compulsive disorder. (Archives of Neuropsychiatry 2014; 51: 355-362)

Objective: Our aim was to investigate cognitive models of OCD via the influence of mothers' cognitive appraisals on children's cognitions and OCD symptoms. Method: Our sample consisted of 21 adolescents with OCD, their mothers and 27 parent child dyads for control group without OCD. Subjects with OCD and their mothers were administered The Beck Depression Inventory (BDI), The Thought Action Fusion Scale (TAFS), The White Bear Suppression Inventory (WBSI), The Padua Inventory-Revised (PI-R) and The Penn Inventory of Scrupulosity (PIS). Results: While the BDI (t = 2.18, p < 0.05) and TAF Morality (t = 2.18, p < 0.05) scores of the mothers of OCD subjects were significantly higher than the mothers of control subjects, the comparisons for the PI, TAF likelihood and PIOS scores of groups were not significant. Intradyadic correlation revealed significant relationships for PI-Rumination, PI-Checking and WBSI scales between the scores of parent and child in OCD dyads, (respectively, r = 0.49, P = 0.11; r = 0.37, P = 0.045; and r = 0.47, P = 0.014). There was no significant relationship in the control group. Conclusion: Our results partially supported that mothers' cognitive appraisals are associated with the cognitive appraisal of adolescents. A cognitive intradyadic interaction between mother and child might be more likely in the presence of OCD in adolescents. (C) 2014 Elsevier Inc. All rights reserved.

PubMed ID: 22395755 A moral/religious subtype of obsessive compulsive disorder has been termed as scrupulosity by mental health professionals. Since ultimate feared consequence in scrupulous individuals is religious or moral in nature, it also presents interesting and difficult issue for religious authorities. This article focuses on various aspects of scrupulosity that have until now been poorly conceptualized in Islamic world and provides a conceptual cognitive framework and analysis of scrupulosity according to Islamic sources. © 2012, Springer Science+Business Media, LLC.

Introduction: The Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report instrument developed to overcome the problems with the available instruments. The aim of this study was to assess the psychometric properties of the revised Obsessive Compulsive Inventory (OCI-R) in Turkish sample. Methods: The psychometric properties of the Turkish version of the Obsessive-Compulsive Inventory-Revised (OCI-R) were assessed in clinical samples (n44 for patients with obsessive-compulsive disorder (OCD), and n44 for patients with major depression (MD) and a non-clinical student sample (n287). Results: The confirmatory factor analysis demonstrated that the original six-factor structure was valid in the Turkish sample. The overall and each of the subscales showed moderate to good internal consistency and convergent validity as well as test-retest reliability. However, the Cronbachs alpha was excessively low for the hoarding subscale in the OCD group. The total and subscale scores of the OCI-R satisfied at discriminating patients with OCD from both patients with MD and healthy controls, with an exception of the neutralizing subscale. Conclusion: The Turkish version of the OCI-R did not reveal sound psychometric properties. Findings are discussed in the light of current theoretical considerations., Giriş: Obsesif-Kompulsif Envanteri-Revize (OKE-R) varolan ölçme araçlarındaki sorunların üstesinden gelebilmek amacıyla geliştirilmiş yaygın olarak kullanılan bir öz değerlendirme aracıdır. Bu çalışmada, Obsesif-Kompulsif Envanterinin revize edilmiş formunun Türk örneklemindeki psikometrik özelliklerinin değerlendirilmesi amaçlanmıştır. Yöntem: Obsesif-Kompulsif Envanteri-Revizenin Türkçe formunun psikometrik özellikleri klinik örneklemlerde (obsesif-kompulsif bozukluk tanısı alan hastalarda n44 ve major depresyon tanısı alan hastalarda n44) ve klinik olmayan öğrenci örnekleminde (n287) ele alınmıştır. Bulgular: Doğrulayıcı faktör analizi sonucunda orijinal altı faktörlü yapının Türk örnekleminde geçerli olduğu bulunmuştur. Ölçeğin tümü ve alt ölçekler için orta düzeyden yükseğe doğru değişen düzeylerde iç tutarlılık, birlikte geçerlik ve test tekrar test geçerliği değerleri elde edilmiştir. İstifleme alt ölçeği için obsesif kompulsif grupta çok düşük Cronbach alfa değeri elde edilmiştir. Nötürleştirme alt ölçeği dışında toplam puanların ve alt ölçeklerin genel olarak obsesif kompulsif bozukluğu olan hastaları sağlıklı kontrollerden ve major depresyon hastalarından başarıyla ayırt edebildiği görülmüştür. Sonuç: Obsesif-Kompulsif Envanteri-Revizenin Türkçe formu için yeterli psikometrik özellikler saptanmamıştır. Bulgular konuya ilişkin kuramsal tartışmaların ışığında ele alınmıştır.

Shift work influences health, performance, activity, and social relationships, and it causes impairment in cognitive functions. In this study, we investigated the effects of shift work on participants' cognitive functions in terms of memory, attention, and learning, and we measured the effects on oxidative stress. Additionally, we investigated whether there were significant relationships between cognitive functions and whole blood oxidant/antioxidant status of participants. A total of 90 health care workers participated in the study, of whom 45 subjects were night-shift workers. Neuropsychological tests were administered to the participants to assess cognitive function, and blood samples were taken to detect total antioxidant capacity and total oxidant status at 08:00. Differences in anxiety, depression, and chronotype characteristics between shift work groups were not significant. Shift workers achieved significantly lower scores on verbal memory, attention concentration, and the digit span forward sub-scales of the Wechsler Memory Scale-Revised (WMS-R), as well as on the immediate memory and total learning sub-scales of the Auditory Verbal Learning Test (AVLT). Oxidative stress parameters were significantly associated with some types of cognitive function, including attention concentration, recognition, and long-term memory. These findings suggest that night shift work may result in significantly poorer cognitive performance, particularly working memory. (C) 2013 Elsevier Ireland Ltd. All rights reserved. Shift work influences health, performance, activity, and social relationships, and it causes impairment in cognitive functions. In this study, we investigated the effects of shift work on participants' cognitive functions in terms of memory, attention, and learning, and we measured the effects on oxidative stress. Additionally, we investigated whether there were significant relationships between cognitive functions and whole blood oxidant/antioxidant status of participants. A total of 90 health care workers participated in the study, of whom 45 subjects were night-shift workers. Neuropsychological tests were administered to the participants to assess cognitive function, and blood samples were taken to detect total antioxidant capacity and total oxidant status at 08:00. Differences in anxiety, depression, and chronotype characteristics between shift work groups were not significant. Shift workers achieved significantly lower scores on verbal memory, attention–concentration, and the digit span forward sub-scales of the Wechsler Memory Scale-Revised (WMS-R), as well as on the immediate memory and total learning sub-scales of the Auditory Verbal Learning Test (AVLT). Oxidative stress parameters were significantly associated with some types of cognitive function, including attention–concentration, recognition, and long-term memory. These findings suggest that night shift work may result in significantly poorer cognitive performance, particularly working memory.

It has been commonly recognized that circadian rhythm and sleep/wake cycle are causally involved in bipolar disorder. There has been a paucity of systematic research considering the relations between sleep and mood states in bipolar disorder. The current study examines the possible influences of sleep deprivation on mood states and endocrine functions among first-degree relatives of patients with bipolar disorder and healthy controls. Blood samples were taken at two time points in the consecutive mornings at predeprivation and postdeprivation periods. Participants simultaneously completed the Profiles of Mood States at two time points after giving blood samples. Plasma T3 and TSH levels increased after total sleep deprivation in both groups. Sleep deprivation induced TSH levels were reversely associated with depression-dejection among healthy controls. A paradoxical effect was defected for only the first-degree relatives of the patients that changes in plasma cortisol levels negatively linked to depression-dejection and anger-hostility scores after total sleep deprivation. Plasma DHEA levels became correlated with vigor-activity scores after sleep deprivation among first-degree relatives of bipolar patients. On the contrary, significant associations of depression-dejection, anger-hostility, and confusion-bewilderment with the baseline plasma DHEA levels became statistically trivial in the postdeprivation period. Findings suggested that first-degree relatives of patients with bipolar disorder had completely distinct characteristics with respect to sleep deprivation induced responses in terms of associations between endocrine Functions and mood states as compared to individuals whose relatives had no psychiatric problems. Considering the relationships between endocrine functions and mood states among relatives of the patients, it appears like sleep deprivation changes the receptor sensitivity which probably plays a pivotal role on mood outcomes among the first-degree relatives of patients with bipolar disorder. (C) 2013 Elsevier B.V. All rights reserved.

Objective Electroconvulsive therapy (ECT) consists of controlled convulsive seizure by electric stimulation of the brain. Although various electrocardiographic (ECG) changes have been reported during ECT, atrial conduction has not been studied extensively. The aim of the present study was to assess the effects of ECT on systemic arterial blood pressure and ECG parameters (P wave duration, P wave dispersion and heart rate). Methods Thirty depressive patients undergoing ECT were included. Echocardiographic examination was performed on all patients before ECT sessions to exclude systolic heart failure and diastolic dysfunction which may affect P wave duration and dispersion. Twelve-lead ECG records were obtained before the first ECT and after the third session of ECT. Blood pressure was measured before and after convulsive therapy session. Results Compared to baseline values, maximum P wave duration (99.3±14.6 to 111.3±8.2 ms, P =.001), P wave dispersion (50±14.8 to 63.3±10.3 ms, P =.001), and systolic (110.7±12 to 116±12.2 mmHg, P =.043) and diastolic blood pressures (70.7±9.4 to 75.3±8.2 mmHg, P =.028) were significantly increased after convulsive therapy session. Conclusions We proposed that ECT alone or in combination with atypical antipsychotics or antidepressants may influence atrial conduction as evidenced by the significantly prolonged maximum P wave duration and P wave dispersion. Longer-term follow-up of patients undergoing ECT may be appropriate to evaluate the possible long-term outcomes of our short-term results.

Objective: There is mounting evidence indicating that oxidative and inflammatory processes may have an important role in the pathogenesis of panic disorder (PD). PD is a heterogeneous disease, and panic attacks are divided according to the different symptom clusters as respiratory, nocturnal, non-fearful, cognitive, or vestibular subtypes. The aim of this study was to compare whole-blood and serum superoxide dismutase (SOD), glutathione peroxidase and adenosine deaminase activities in PD patients with/without nocturnal, respiratory subtypes and healthy subjects. Methods: The study was conducted including 60 patients with PD and 30 healthy control subjects. The Panic Attack Symptom Checklist, Panic and Agoraphobia Scale, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were administered to the patients. Biochemical analyses were performed after all the blood samples were collected. Results: We found that whole-blood SOD and glutathione peroxidase activities of patients were significantly lower and adenosine deaminase activities of patients were higher than those of healthy controls. There were no statistically significant differences between respiratory and nocturnal subtypes. In addition, there were no marked relationships between the duration of illness and panic-agoraphobia scores of patients with nocturnal subtypes. Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores of patients with the nocturnal subtype were markedly higher than those of patients without the nocturnal subtype. Conclusion: The results suggest that oxidative and inflammatory processes may play a role in the pathophysiology of PD. These findings may support the idea that both nocturnal and respiratory subtypes of PD have different symptom clusters of the same disease. Copyright (C) 2012 S. Karger AG, Basel Objective: There is mounting evidence indicating that oxidative and inflammatory processes may have an important role in the pathogenesis of panic disorder (PD). PD is a heterogeneous disease, and panic attacks are divided according to the different symptom clusters as respiratory, nocturnal, non-fearful, cognitive, or vestibular subtypes. The aim of this study was to compare whole-blood and serum superoxide dismutase (SOD), glutathione peroxidase and adenosine deaminase activities in PD patients with/without nocturnal, respiratory subtypes and healthy subjects. Methods: The study was conducted including 60 patients with PD and 30 healthy control subjects. The Panic Attack Symptom Checklist, Panic and Agoraphobia Scale, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were administered to the patients. Biochemical analyses were performed after all the blood samples were collected. Results: We found that whole-blood SOD and glutathione peroxidase activities of patients were significantly lower and adenosine deaminase activities of patients were higher than those of healthy controls. There were no statistically significant differences between respiratory and nocturnal subtypes. In addition, there were no marked relationships between the duration of illness and panic-agoraphobia scores of patients with nocturnal subtypes. Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores of patients with the nocturnal subtype were markedly higher than those of patients without the nocturnal subtype. Conclusion: The results suggest that oxidative and inflammatory processes may play a role in the pathophysiology of PD. These findings may support the idea that both nocturnal and respiratory subtypes of PD have different symptom clusters of the same disease.

Objective: Many physiological and pathological processes, such as infections, environmental toxins, and ionizing radiation increase bodily concentrations of oxidizing substances, known as free radicals, which lead to neuro-degenerative disorders. Sleep is one of the most important factors contributing to health; however, insomnia is among the most prevalent health complaints. Objective: Many physiological and pathological processes, such as infections, environmental toxins, and ionizing radiation increase bodily concentrations of oxidizing substances, known as free radicals, which lead to neurodegenerative disorders. Sleep is one of the most important factors contributing to health; however, insomnia is among the most prevalent health complaints.Methods: In this study, for the first time in the literature,we investigated the effects of primary insomnia on certain oxidative stress biomarkers. For this purpose, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities and levels of reduced glutathione (GSH) and malondialdehyde (MDA) were measured in 30 patients with primary insomnia and 30 healthy volunteersResults: Our results show that the patients with primary insomnia had significantly lower GSH-Px activity and higher MDA levels compared with the controls.Conclusion: These results may indicate the important role of sleep in attenuating oxidative stress.

Objective. Previous studies have indicated that obsessive compulsive disorder (OCD) is associated with childhood traumatic experiences and higher levels of dissociation. Dissociative tendency may arise when individual attempt to incorporate adverse experiences into cognitive schema. Methods. We investigated the possible links among childhood trauma, dissociation, and cognitive processes. We evaluated 95 patients with OCD using the Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), White Bear Suppression Inventory (WBSI), Dissociative Experiences Scale (DES), and Childhood Trauma Questionnaire (CTQ-28). Results. The CTQ-28 total scores were not associated with Y-BOCS total, Y-BOCS insight, BDI, TAFS, MCQ-30, and WBSI scores. The TAFS Total, MCQ-30, WBSI, and BDI scores were significantly associated with DES scores. Regression analysis revealed that MCQ-30 and WBSI scores significantly predicted the DES scores. Conclusions. These results suggest that in spite of pathological connotation of dissociative experiences, dissociation may primarily constitute a cognitive trait which is strongly associated with cognitive processes.

IntroductionCognitive models hypothesize that certain dysfunctional beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of obsessive-compulsive disorder (OCD). There is no consensus about which characteristics of OCD patients more likely to be associated with better treatment response.ObjectivesWe aimed to investigate whether obsessive beliefs change over time in the OCD patients receiving Serotonin Reuptake Inhibitors. We also investigated the effect of change in obsessive beliefs on psychopharmacological treatment response.MethodsA sample of 75 patients with OCD were interviewed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HDRS). To measure dysfunctional beliefs, they were administered the Obsessive Beliefs Questionnaire-44 (OBQ-44) which contains three subscales; threat overestimation and responsibility, importance and control of intrusive thoughts, and perfectionism and need for certainty.ResultsThe seventy-six percent (n=57) patients completed the treatment period and they were reassessed after 12 weeks with the Y-BOCS, HDRS and OBQ-44. The mean change scores of responders for OBQ-44 Responsibility/Threat Estimation and OBQ-44 Perfectionism/Certainty were not significantly differing from those of non-responders. The mean change in responders for OBQ-44 Importance/Control of Thoughts and HDRS were significantly higher than non responders.ConclusionsOur results suggest that treatment response to pharmacotherapy in OCD is negatively associated with the obsessive beliefs about perfectionism and certainty. The alleviation of negative mood by SRIs may not allow the sufferer disengages from dysfunctional appraisals.

Objective To investigate the comparative efficacy of aripiprazole and risperidone as augmenting agents in the treatment of obsessive-compulsive disorder (OCD) patients who did not show a ≥35% decrease in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) after 12-week monotherapy with selective serotonin reuptake inhibitors (SSRIs). Methods The study consists of two different periods of treatment: a 12-week prospective period to determine resistance to SSRI treatment and an 8-week single-blind addition period for refractory patients only. Ninety patients were randomly assigned to receive one of the SSRI treatments. Sixty-nine patients (76.6%) completed the 12-week SSRI monotherapy period. Forty-one patients (59.4%) were considered refractory and were randomised to receive either risperidone (20 patients, 3 mgr daily) or aripiprazole (21 patients, 15 mgr daily) as augmentation to SSRI treatment. Sixteen patients (76.2%) in the aripiprazole group and 18 patients (84%) in the risperidone group completed the 8-week treatment period. Results Eight patients (50%) in aripiprazole and 13 patients (72.2%) in risperidone group met response criteria of Y-BOCS decrease ≥35% at the end of the study. The risperidone group showed a significant improvement in Y-BOCS obsession scores compared with aripiprazole. Conclusions The present findings suggest that risperidone may be more effective than aripiprazole. Copyright © 2011 John Wiley & Sons, Ltd.

Objective: We aimed to assess whether cognitive processes change over time in patients with obsessive-compulsive disorder (OCD) receiving selective serotonin reuptake inhibitors without cognitive behavioral therapy and to investigate the factors associated with probable cognitive changes. Methods: During the 16 weeks of the study, 55 patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for OCD received open-label treatment with sertraline (100-200 mg/d) or fluoxetine (40-80 mg/d) and were assessed using the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), and White Bear Suppression Inventory (WBSI). Results: The Yale-Brown Obsessive-Compulsive Scale (P < .001), BDI (P < .001), TAFS morality (P < .005), MCQ-30 (P < .01), and WBSI (P < .005) scores at follow-up were significantly lower than baseline scores. When we excluded OCD patients with depressive disorder (n = 12), statistical significance in paired comparisons for MCQ and WBSI disappeared. Similarly, when OCD patients with religious obsessions (n = 16) were excluded, paired comparisons for MCQ and TAF morality were not statistically significant. Changes in BDI, TAFS morality, MCQ-30, and WBSI (P < .005) were significantly correlated with changes in severity of obsessions, but not that of compulsions. After controlling for the change in depression severity, significant correlations between changes in obsessive and cognitive scales did not continue to have statistical significance. The BDI changes (P < .05) significantly explained the changes in symptom severity in a linear regression model. Conclusions: Our findings suggest that selective serotonin reuptake inhibitors can change appraisals of obsessive intrusions via their effects on negative emotions.

Inconsistent results have been found in the studies evaluating the effect of both total and partial sleep deprivation (SD) on mood in healthy subjects and a few variables have been analyzed as possible predictors. In the present study, we examined whether circadian preference modifies the effect of SD on mood changes in healthy subjects. Sample consisted of 60 healthy volunteers (including 30 morningness and 30 eveningness subjects). Then, the two groups were again divided into two groups for two SD procedures. Fifteen morningness and 15 eveningness chronotypes were total sleep deprived and 15 morningness and 15 eveningness subjects were partial sleep deprived. The mood changes were evaluated before and after SD using Profile of Mood States. Two main results were obtained from our study: a significant increase in depression subscale in morningness chronotypes and a significant decrease in depression subscale score after total SD (TSD) in eveningness chronotypes. The changes in depression-dejection scores of eveningness chronotypes after total (P < 0.01) and partial SD (P < 0.01) were significantly different from changes in morningness chronotypes after TSD. Our results suggest that the effect of SID on mood in normal subjects is related to their circadian preferences. The morningness or eveningness characteristics of the shift workers have significant impact on their mood states. Therefore, adjusting the work schedule with the morningness and eveningness characteristics of the workers may improve their mood alterations.

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36 +/- 8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes-autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

Objective. The clinical characteristics and response to pharmacotherapy of adult patients with early-onset and late-onset obsessive-compulsive disorder (OCD) were compared in this study. Methods. A total of 50 outpatients with OCD diagnosed according to DSM-IV criteria (early-onset: 20; late-onset: 30) were included in the study. After initial clinical evaluation with The Structured Clinical Interview for DSM-IV/Clinical Version (SCID-I/CV), The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), all patients were treated with fluvoxamine, sertraline or paroxetine for 12 weeks. Treatment response was defined as a >= 35% reduction in the Y-BOCS-total scores from baseline in a 12-week follow-up period. Results. Forty-three patients (early-onset: 16; late-onset: 27) completed the study. The early-onset group had higher frequencies of symmetry/exactness obsessions and ordering/arranging compulsions, and the late-onset group had higher mean age at assessment. Nine (56.3%) patients with early-onset and 18 (66.7%) with late-onset responded to pharmacotherapy. The difference between response rates was not statistically significant. Conclusions. Our study suggests that although there are some phenomenological differences between patients with early-onset OCD and late-onset OCD, these patients have similar responses to pharmacotherapy.

Objectives Recently, there has been a growing interest in the relationship between sleep disturbances and suicidality in major depression. Sleep disturbances are one of the ‘modifiable risks’ for suicide in major depression. The present study examines whether there is a relationship among nightmares, suicide attempts, and melancholic features in unipolar major depressed patients. Methods One hundred (49 males and 51 females) depressed patients with melancholic features and 49 (23 males and 26 females) patients without melancholic features were included in the study. All patients were classified as those who attempted suicide at least once during current depressive episode and as those who never attempted. Results Melancholic attempters had higher rates of nightmares, middle, and terminal insomnia than melancholic non-attempters. There was no significant difference between non-melancholic patients with and without suicidal attempts in terms of the frequency of all types of insomnia and nightmares. Limitations: This study does not have polysomnographic records for sleep variables. Conclusions Feeling worse in the morning than later in the day may be related to the intervening dream content and affect and predict suicidal tendency. Melancholia may be associated with increased risk of suicide attempts due to repetitive and frightening dreams.