Association of mindfulness and impulsivity with obesity

Background: The prevalence of obesity has more than doubled over the past three decades. Impulsivity is a multidimensional personality trait that potentially contributes to the development and maintenance of obesity. Mindful awareness can potentially minimize the automatic and inattentive reactions around food. Objectives: In our study, we aimed to research the relationship between impulsivity and mindful attention. Methods: The study population consisted of 60 outpatients aged 18 and older, with a body mass index (BMI) of at least 30 kg/m2 presenting to the psychiatry clinics of a secondary health care facility. The participants completed the Barratt Impulsiveness Scale (BIS), and the Mindful Attention Awareness Scale (MAAS). Results: The average age of participants was 39 years, BMI was 35.70 ± 4.54 kg/m2. BMI was not statistically significantly correlated with any of the scales, and the MAAS total score was negatively correlated with the impulsiveness scores, except for the motor impulsiveness subscale score. Dispositional mindfulness was negatively associated with impulsiveness scores, except for motor impulsiveness. Discussion: This study showed that there was a negative relationship between impulsivity and mindfulness. Therefore, using mindfulness techniques may decrease impulsivity, and may be extremely helpful in promoting better eating behaviors and weight regulation

Metabolic syndrome in bipolar disorder: prevalence, demographics and clinical correlates in individuals with bipolar I, bipolar II, and healthy controls

Background: The metabolic syndrome is a growing global public health problem and highly prevalent in patiens with bipolar disorder. There are a few studies about relationship between metabolic syndrome and bipolar disorder subtypes. Objective: The aim of this study was to investigate the prevalence of metabolic syndrome (MS) and its individual components in subjects with bipolar I (BD I) and bipolar II (BD II) disorder compared with non-psychiatric controls, and to determine the variables affecting MS. Methods: A total of 210 individuals (mean age 42.5 ± 11.87, 58.1% female) of whom 70 had BD I, 70 BD II, and 70 controls, were included in this study. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the adapted ATP III (ATP III-A) and the International Diabetes Federation (IDF) criteria. Results: Participants with BD I had a significantly higher prevalence of MS when compared to individuals BD II and non-psychiatric controls according to the NCEP-ATP III, ATP III-A, and IDF criteria (ps < 0.01). In individuals with MS, increased waist circumference was the most common abnormality. Logistic regression analysis revealed that the presence of physical illness, age and number of cigarettes smoked significantly predicted the presence of MS. Discussion: This study showed that MS was more prevalent among BD I individuals compared to BD II and controls, and highlighted the importance of regular screening for MS in individuals with BD

Simple markers for subclinical inflammation in the different phases of bipolar affective disorder

Abstract Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflam mation in BD

The effectiveness of suicide risk assessment tools in predicting the need for hospitalization

Objective: In this study, adults presenting to the emergency room after a suicide attempt were evaluated by means of some suicide risk assessment tools, and the effectiveness of these tools in identifying those who needed to be hospitalized was investigated. Method: A total of 60 participants were included in the study. The clinical risk assessment of a psychiatrist was considered to be the gold standard for evaluation, and the consistency of the scores obtained by the tools used in the study (Modified “SAD PERSONS” Scale, California Suicide Risk Estimator, Suicide Risk Assessment Tool) were compared with this gold standard by receiver operating curves (ROC). For each tool, the optimal cut-off score, and its sensitivity and specificity at this value, which identified those who needed to be hospitalized were calculated. Independent samples’ t test was used to demonstrate whether the clinical assessment and the cut-off scores of the tools were able to differentiate the groups who needed to be hospitalized or not. The relationship between the clinical assessment and the tools was investigated by Pearson correlation analyses. Results: The sensitivity of the assessment tools for the need for hospitalization ranged from 44.4% to 72.2%, and their specificity ranged from 81.0% to 95.2%. No differences were found between the ROCs of the assessment tools when they were compared with each other. The cut-off scores of the assessment tools managed to differentiate those who needed to be hospitalized. Discussion: Although the assessment tools may not replace the clinical risk assessment of a psychiatrist, some of them may be helpful for the emergency room healthcare staff in identifying the adults who need to be hospitalized after an attempted suicide

Analysis of the psychiatric consultations for inpatients and from the emergency room in a university hospital: A comparison with studies from Turkey

Objective: The aim of this research was to assess the characteristics of the consultations required in a psychiatric department of a university hospital, and the distribution of psychiatric disorders in hospitalized patients and patients admitted to the emergency room. Method: In the study, the data of 539 patients 18 years or older (48.67 ± 20.91 years) (46.8% women) who were hospitalized and who presented to the emergency room between 01/01/2015 and 31/12/2015, and for whom a psychiatric consultation was requested were recorded onto a structured form. Patients' electronic databases were reviewed retrospectively for the specified date range. Descriptive statistical analyzes (frequency of data, distribution, mean, standard deviation) were performed for the data examined in the study. Results: Medical departments (42.9%), surgical departments (31.7%) and the emergency medicine department (25.4%) were the most frequently psychiatric consultation requesting departments. The most frequent requests for consultation were agitation (15.4%), depressive symptoms and signs (14.7%) and suicide attempts (12.2%). The most frequent psychiatric diagnoses were depressive disorders (19.5%), delirium (18.2%) and schizophrenia and other psychotic disorders (7.4%). Musculoskeletal diseases (17.4%), mental disorders (15.0%), oncologic diseases (14.1%) and suicide attempts (12.2%) were the primary diagnoses of patients. Discussion: Consultation and liaison psychiatry services have an important role in our relationship with other departments in medicine. Priority to training of depressive disorders, delirium and suicide attempts should be offered to healthcare providers working in these departments

The Conceptual Foundations of Metacognitive Therapy

This introductory review article aims to provide the interested reader with an outline of the fundamentals of metacognitive therapy. Metacognitive therapy (MCT) is an evidence based cognitive behavioural psychotherapy approach with a very solid theoretical background in understanding and explaining the mechanisms by which any psychological disorder persists. MCT provides a new perspective for the treatment of psychological disorders by underlining the significance of how a person thinks, rather than simply focusing on the content of his cognitions. The case formulation and specific techniques of MCT are the main distinctive features of this therapy approach, which places it in a unique position among other CBT approaches. These distinctive features are defined throughout the article. A short introduction to the metacognitive model of psychological disorder, the core features of this therapy, and the specific techniques of MCT are also summarized. A brief list of clinical scales and treatment plans as well as the order of application of MCT techniques are also given. This review article aims to underline the theoretical background of MCT, and hopes to provide a glimpse into the introductory level principles of the application of this therapy approach. [JCBPR 2014; 3(1.000): 11-17

TRANSDİYAGNOSTİK BİLİŞSEL DAVRANIŞÇI TERAPİ: BİR ÖRNEK OLARAK BÜTÜNLEŞİK PROTOKOL

Kategorik sınıflandırmaya imkân veren yaklaşımların pek çok kısıtlılığının olması, tanılardan ziyade tanıların altında yatan ortak psikopatolojik süreçlere odaklanan ve kesitsel yerine boylamsal (uzunlamasına) değerlendirmeyi vurgulayan transdiyagnostik (ötetanısal, tanıötesi) yaklaşımların (TY) öne çıkmasına yol açmıştır. TY ruhsal bozuklukların ortaya çıkmasında ve sürmesinde altta yatan ortak psikopatolojik süreçlere odaklanır. Böylelikle kategorik açıdan bozukluklar farklı şekilde tanı alsa dahi birbirleriyle ne açıdan örtüştükleri ya da ayrıştıkları tespit edilebilir. TY, bu yönleri kullanarak ruhsal bozuklukları tedavi etmeyi amaçlar. TY, bilişsel davranışçı terapilerin işleyişine kolaylıkla entegre edilebilecek esnek ve modüler bir yapıya sahiptir. Bu gözden geçirme yazısının geri kalan kısmında en popüler TY örneklerinden biri olan Bütünleşik Protokol (BP) üzerinde durulacaktır. BP’de temel amaç hastaların duygularını tanımaları ve olumsuz nitelikteki duygularına daha işlevsel tepkiler vermelerini sağlamaktır. Bu doğrultuda BP sekiz modülden oluşur. Modüller genellikle haftada bir sıklıkta, her biri 50 – 60 dakika süren bireysel görüşmeler ile toplam 11 – 17 hafta içerisinde tamamlanabilir. Gereklilik olması halinde modüllere ayrılan oturum sayılarında veya oturumların sıklığında değişiklik yapılabilir. BP’nin her bir modülü hedefleri ve bu hedeflere dönük tedavi yaklaşımları son derece net bir şekilde belirlenmiş bir yaklaşıma imkân verir. Bu nedenle BP’nin uygulamaya geçirilmesinden önce detaylı bir değerlendirme, olgu kavramsallaştırması ve tedavi planı ortaya çıkarma gereği vardır. BP konusundaki gelişmelere Türkiye’den ruh sağlığı ve hastalıkları uzmanları ve çalışanlarının da katkı yapması ümit edilmektedir

Transdiagnostic Cognitive Behavioral Psychotherapy: Unified Protocol as an Example

The fact that there are many limitations of the current classification systems led to the emergence of transdiagnostic approaches (TA) that focus on the common psychopathological processes underlying disorders rather than categorical diagnoses. TA focuses on the underlying common psychopathological processes in the emergence and persistence of mental disorders. Thus, even if the disorders are categorically diagnosed differently, it can be determined how they overlap or separate with each other. TA aims to treat mental disorders using these aspects. TA has a flexible and modular structure that can be easily integrated into cognitive behavioral therapies. The rest of this review will focus on the Unified Protocol (UP), one of the most popular TA examples. The main purpose of the UP is to enable patients to recognize their feelings and give more adaptive reactions to their negative emotions. Accordingly, UP consists of eight modules. The modules can usually be completed in a total of 11 - 17 weeks. Each 50 to 60-minute individual session is held once a week. If necessary, changes can be made to the number or the frequency of sessions allocated to modules. The goals of each module of the UP and the treatment approaches towards these goals allow a very clearly defined approach. For this reason, there is a need for a detailed evaluation, conceptualization and treatment plan before the UP is put into practice. We hope that mental health professionals from Turkey will contribute to the developments in the UP

Cognitive Distortions in Depressed Women: Trait, or State Dependent?

Objective: According to the cognitive theory developed by Beck, cognitive distortions are important mediators for the onset and maintenance of depressive disorders. It has not been researched if these cognitive distortions are more frequently encountered during the depressive episode, or if they are trait-like features. This study aims to investigate this. The hypothesis of the study is that cognitive distortions are state dependent. Method: Three groups of outpatients (n=178 patients in acute major depressive episode, n=168 depressive patients in remission, n=177 healthy controls) presenting to the psychiatry clinics of three different state hospitals were recruited for the study. The participants were diagnostically interviewed by the MINI according to the DSM-IV criteria. The participants were asked to complete the Cognitive Distortions Scale and the severity of their depression was measured by the Inventory for Depressive Symptomatology. Results: According to the cognitive distortion subscales, except for the self-blame subscale, the acute depressive group scored the highest. Also it was found that the cognitive distortions of the depressive populations, except for the self-blame related ones, statistically differed from the healthy controls. Self-blame related distortions were mood state dependent. Conclusion: The results have revealed that self-criticism, helplessness, hopelessness and preoccupation with danger related distortions had trait-like features, whereas self-blame related distortions were state dependent. This has clinical implications for the psychotherapeutic treatment of cognitive distortions in depression. Specifically, self-criticism related distortions should be managed during cognitive therapy for depression since the other subscales seem rather problematic. [JCBPR 2015; 4(3.000): 147-152