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Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (ß = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (ß = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.

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BACKGROUND: The causes underlying suicidal behaviour in patients with obsessive-compulsive (OCD) are not fully understood. AIM: In this study, we examined whether lifetime suicide attempt (SA), and suicide ideation (SI) was associated with affective temperaments, impulsivity, childhood traumatic events or separation anxiety. METHODS: We compared OCD patients with lifetime SA (Group 1; n=25), lifetime suicide ideation (SI) (Group 2; n=62), and without lifetime SI and SA (Group 3; n=73) through Beck Scale for Suicidal Ideation (BSSI), Childhood Trauma Questionnaire Questionnaire (CTQ-SF), Separation Anxiety Symptom Inventory (SASI), Baratt Impulsiveness Scale (BIS-11), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), and Beck Depression Inventory (BDI). RESULTS: Post hoc tests showed that educational level was significantly lower in Group 1 than in both Group 2 and 3. Childhood abuse were significantly higher in attempters than ideators, and non-suicidal patients. The depressive, cyclothymic, and anxious temperaments were significantly higher in attempters and ideators compared to control subjects. The aggressive obsessions (p=0.002), childhood abuse history (p=0.009), lifetime major depression (p=0.017), and lower educational levels (p=0.006) strongly predicted the increased risk of lifetime SA, compared to non-suicidal patients. Childhood abuse (p=0.022) was the most significant predictor of lifetime SA in OCD. CONCLUSION: We suggested that childhood abuse history emerged as the most significant variable that distinguished lifetime attempters from only ideators in OCD patients.

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BACKGROUND: The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. METHODS: Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. RESULTS: High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. CONCLUSION: These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.

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Abstract Background The mediating role of childhood trauma in the relationship between schizotypal symptoms and obsessive-compulsive disorder (OCD) was not sufficiently investigated to date. Objectives In the present study, our major goal was to analyse the mediator role of childhood abuse (emotional, physical, and sexual), and neglect (emotional and physical) on the link between schizotypal symptoms and OCD, after controlling for duration of OCD, the mean number of comorbid Axis I disorders, and current anxiety. Methods One hundred fifteen patients (aged 18-65 years) who had primary diagnosis of OCD and Yale-Brown Obsessive-Compulsive Scale score ≥16 were assessed using the short form of Childhood Trauma Questionnaire questionnaire (CTQ-SF), Schizotypal Personality Questionnaire (SPQ), and Beck Anxiety Inventory (BAI). Results The all types of schizotypal symptoms were significantly correlated with the scores of childhood abuse and neglect, and BAI. The childhood abuse as a mediator significantly predicted the total YBOCS scores (p = 0.02) after when BAI scores were controlled. However, childhood neglect was not multivariately related to current OCD severity, and did not mediate the relationship between schizotypal traits and total YBOCS scores. Discussion We suggested that childhood trauma mediated the schizotypal traits in relationship with current OCD severity independent from anxiety severity.

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OBJECTIVE: The primary objective of this study was to compare the adult-onset and adolescent obsessive-compulsive disorder (OCD) patients in terms of the subthreshold autistic traits. METHODS: 29 adolescent, and 45 adult-onset OCD patients were assessed by Autism-spectrum Quotient (AQ). RESULTS: The ratio of males to females, the frequency of ritualistic compulsions, and the mean number of lifetime compulsions were significantly higher in adolescents with OCD compared to adult-onset patients. Adult-onset OCD patients had significantly higher scores on total, social skills, attention shifting, and imagination subscales of AQ than adolescent OCD patients. The mean number of compulsions, attention shifting scores of AQ, and female gender significantly predicted the distinction between adolescent and adult-onset OCD patients. In adult-onset patients, there were significant correlations between the mean number of lifetime obsessions and total, social skills, attention switching, communication, and imagination subscale scores of AQ. CONCLUSIONS: We suggest that subthreshold autistic traits may play a significant role in the occurence of obsessive-complusive symptoms (OCS) in adult-onset OCD. Autistic traits seemed to be higher and had an closer relationship with the frequency of lifetime obsessions in AO-OCD patients than in adolescent patients.

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Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.

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ABSRACT We aimed to investigate the relationship between affective temperaments and the severity of nausea and vomiting symptoms in early pregnancy (NVP). The pregnant women who did (n = 187) or did not report (n = 71) any nausea and vomiting at three consecutive assessments with the Pregnancy-Unique Quantification of Emesis Scoring Index (PUQE) (n = 71) were examined. Affective temperamental traits were assessed by Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A). The anxious (p < .0001), depressive (p = .003), cyclothymic (p = .03) and irritable (p = .021) temperament traits in NVP patients were significantly higher than in controls. There were significant correlations between the PUQE scores and depressive (p = .002), cyclothymic (p = .001), irritable (p = .001) and anxious (p = .001) traits. Anxious temparement (p = .004) and being a housewife (p = .012) were significantly associated with NVP. Our results suggest that women with a predominantly anxious temperament are more vulnerable to developing somatic complaints such as nausea and vomiting during pregnancy. IMPACT STATEMENT What is already known on this subject? Although some studies have examined the link between NVP and some psychiatric disorders, to our knowledge the relationship between NVP and affective temperament has not been well investigated. What do the results of this study add? Predominantly anxious temperament make the individuals vulnerable to develop some somatic complaints such as nausea and vomiting during pregnancy. What are the implications of these findings for clinical practice and/or further research? The association of temperament and NVP might be linked to a psychosomatic process in pregnancy. Future research are required to examine the associations of temperament with NVP by including several other biological, social and psychological variables.

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In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (ß = 0.305, p= 0.007). The severity of current depression (ß = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (ß = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

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The association of lifetime suicidal behaviors with anxiety disorders (ADs) in patients with bipolar disorder (BD) has been controversial. In this study, we hypothesized that certain types of ADs were related to the occurrence of past suicide attempts (SAs) independent of the severity of the BD, including the presence of past affective episodes. Lifetime diagnoses of BD and ADs were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders (SCID-I). Of the total sample of 200 patients with BD, 32.0% had at least 1 past SA. The mean number of previous hospitalizations, a history of social AD, and a history of posttraumatic stress disorder were strongly associated with past SAs in patients with bipolar I disorder. The presence of lifetime social AD was associated with lifetime SAs independent of previous depressive episodes. Therefore, we suggest that social AD itself is associated with a greater risk for SAs in patients with BD independent of the presence of depression.

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AIM: The risk factors for depressive symptoms in patients with Parkinson's disease (PD) under dopaminergic drug treatment are unclear. In this study, we examined whether some temperament traits are related to the presence of comorbid depression in PD patients, independent of the characteristics of illness and drug treatment. METHODS: The participants in this study were 74 patients with idiopathic PD who were already treated with stable doses of levodopa or dopamine agonists. Depressive (n = 20) and non-depressive (n = 52) PD patients were assessed by means of the Unified Parkinson's Disease Rating Scale, Beck Depression Inventory, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire. The doses of levodopa and dopamine agonists were converted into levodopa equivalent daily dose. RESULTS: The duration of treatment in the depressive group was significantly longer than in the non-depressive group (P = 0.03). The depressive patients had significantly higher scores on the Unified Parkinson's Disease Rating Scale than the non-depressive patients. Depressive (P < 0.0001), cyclothymic (P < 0.0001), anxious (P < 0.0001), and irritable (P = 0.02) temperament scores were significantly higher in depressive than in non-depressive patients. Hyperthymia scores were significantly higher in non-depressive patients than in depressive patients (P = 0.01). Logistic regression analysis revealed that depressive temperament traits (P = 0.03) significantly predicted the diagnosis of depression. In contrast, hyperthymic temperament seemed to be associated with the absence of depression (P = 0.006). CONCLUSION: Our results indicated that the severity of PD and duration of dopaminergic treatment were not predictive of the development of depression in PD patients. Depressive temperament strongly predicted the development of depression in our sample. Hyperthymic temperament seemed to be associated with patients without depression. We suggest that depressive temperament traits seem to be related to depression, while hyperthymic temperament may have a protective role in the risk of depression in PD patients.

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BACKGROUND: The biological and psychological aspects of post-stroke depression (PSD) may vary based on the time since stroke onset. The sociodemographic and clinical correlates of early-onset PSD are not yet well understood. In the present study, we aimed to investigate the clinical correlates of early-onset depression following first stroke. We hypothesized that the severity of a stroke or disability (other than lesion characteristics) would likely be related to PSD in a sample of first stroke patients with single and unilateral lesions. METHODS: Post-stroke patients with (n = 40) and without (n = 51) early-onset depression were compared with respect to several demographic and clinical variables. RESULTS: There were no significant differences between the groups with respect to lesion location, lateralization, or volume. Scores on the Brief Disability Questionnaire, National Institutes of Health Stroke Scale, and Modified Rankin Scale were significantly higher in depressed post-stroke patients than in non-depressed patients. The anxiety, depression, and total scores of the Hospital Anxiety and Depression Scale were positively correlated with the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Brief Disability Questionnaire scores. A previous history of depression and Brief Disability Questionnaire score were strongly associated with the occurrence of early-onset PSD. CONCLUSION: Our findings suggest that early-onset PSD is likely to be correlated with the severity of stroke and functional disability.

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BACKGROUND: Disulfiram implantation is a widely used treatment alternative for alcohol abuse, yet reports on the surgical aspect of disulfiram implantation with respect to patient and drug-related treatment efficacy and wound complications are very limited. We present our clinical experiences with disulfiram implantation and discuss the surgical outcomes obtained with different anatomical planes for implantation. METHODS: Medical records of all patients referred to our clinic from the psychiatry department between 2007 and 2013 for disulfiram implantation were retrospectively analyzed. Implantation was carried out using 10 sterile Disulfiram tablets (WZF Polfa S.A.), each tablet containing 100 mg of disulfiram. The procedure was carried out by implanting the tablets randomly in either a subcutaneous or an intramuscular plane. The location and the plane of implantation and the complications were recorded for each patient and compared to determine the differences in the outcomes. RESULTS: A total of 32 implantation procedures were evaluated for this study. Twenty-five implants were placed in the intramuscular plane (78.2%), while seven implants were placed subcutaneously (21.8%). Exposure was encountered in three of the seven subcutaneous implants (42.9%), while no exposure was seen with the intramuscular implants. Incomplete absorption of the tablets was encountered in one patient with a previous subcutaneous implant who presented 1 year later for re-implantation as part of the continuation of therapy. CONCLUSIONS: To overcome the issue of treatment continuation in the case of disulfiram therapy, which may be ceased due to frequently encountered wound complications, we believe that implantation in the subscapular intramuscular plane allows both uneventful healing and an out-of-reach implant location.

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The aim of this study was to evaluate the effects of traumatic childhood events and recent adverse life events, as well as the Disrupted in Schizophrenia-1 (DISC1) gene polymorphisms on types of last acute symptoms of patients with schizophrenia. Hundred patients with schizophrenia were given the Childhood Trauma Questionnaire, the Social Readjustment Rating Scale, Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scale (BPRS), and Calgary Depression Scale for Schizophrenia (CDSS). The patients' and healthy controls' DISC1 gene was evaluated for the -274G>C, c.791G>A, and c.2110A>T polymorphisms. There was no statistically significant difference with regard to the DISC1 gene polymorphisms between patient and healthy control groups. No significant relationship was found between the -274G>C, c.791G>A, and c.2110A>T haplotypes and development of different acute symptoms of schizophrenia. Having a recent stressful life event significantly affected SAPS (95% confidence interval [CI]=-67.547, -21.473; p=0.00) and BPRS-1 scores (95% CI=-51.405, -6.885; p=0.01), whereas emotional abuse at childhood significantly affected SANS scores (95% CI=-37.300, -10.401; p=0.00). This study shows that features of acute symptoms in schizophrenia are not influenced by the polymorphisms on the DISC1 gene, but are influenced by recent adverse life events and emotional abuse at childhood.

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