Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

OBJECTIVE: The aim of this study was to assess sociodemographic and clinical correlates of poor treatment adherence among outpatients with bipolar disorder (BD) in remission period. METHODS: This was a cross-sectional study carried out in a University Hospital in Turkey, and 117 outpatients with BD according to DSM-IV-TR criteria were included. All participants were administered a sociodemographic form, the SCID-I, the Morisky 8-item Medication Adherence Questionnaire, the Hamilton Depression Scale, the Young Mania Rating Scale, Schedule for Assessing the three components of insight, and Global Assessment of Functioning Scale. Collected data were analysed via descriptive statistics and logistic regression was used to determine significant variables. RESULTS: Patients with poor treatment adherence were low educated, were more likely to be not married, and had a greater prevalence of anxiety disorder comorbidity. The patients with poor adherence also showed more subsyndromal depressive symptoms but no significant differences were seen in terms of age, gender, living status, social support, or number of episodes between patients with good and poor adherence. Logistic regression analyses revealed that comorbid anxiety disorder, lower education level, and duration of depression period were the main predictors of poor adherence. CONCLUSION: This outcome is consistent with previous studies, and assuring complete adherence in all bipolar patients is difficult, but increasing the number of adherent patients is possible and substantial for sufficient outcome. Improving subsyndromal symptoms and awareness of the patient about the features of the disorder may provide better adherence to treatment and greater functionality of the patient. Psychotherapeutic interventions and psychoeducation should be implemented along with the medical treatment to improve subsyndromal symptoms and to avoid treatment maladherence in advance. Further research is needed to assess the role of interventions in treatment adherence of patients with BD

Investigation of the Processing of Noun and Verb Words with fMRI in Patients with Schizophrenia

WOS: 000531813000003PubMed: 32110143Introduction: Action naming is reported to be more damaged in patients with schizophrenia than object naming. Aim of this study is to understand the cortical mechanism underlying the negative symptoms seen in patients with schizophrenia such as inactivity, restricted behavioral repertoire, by using functional MRI (fMRI) to determine whether the action origin words have a different representation in the brain regions of patients with schizophrenia and healthy individuals. Our hypothesis is that restriction in the repertoire of movement and behavior and the failure of words of "action" than words of "object" are interrelated through the same cortical mechanisms. If this hypothesis is correct, the reason for not taking action in patients with schizophrenia may be improper definition of the action (verb). Methods: fMRI study was conducted with 12 patients with schizophrenia and 12 healthy individuals. fMRI recording was performed after applying positive and negative syndrome (PANSS) scale, Calgary depression scale, hand preference scale to the participants. During the sessions, lexical decision task' is applied by showing a total of 240 words (120 words - 60 verbs (words of action) and 60 nouns (words of object) - and 120 non-words) to the subjects. Results: In fMRI findings, in the group main effect, which can also he expressed as the difference of the noun and verb words in the group of schizophrenia from the noun and verb words in the healthy control group, the activation of the anterior prefrontal cortex is found to be lower in patients with schizophrenia than in healthy individuals. When the brain areas which show the difference in verb words in schizophrenia group from both noun words in schizophrenia group and noun and verb words in healthy individuals are examined, inferior frontal gyrus pars triangularis (BA45) showed more activation in patients with schizophrenia than healthy individuals, but again for the same task, inferior frontal gyrus pars opercularis (BA44) and left primary sensory area showed less activation in patients with schizophrenia than healthy individuals. There is no difference between patients with schizophrenia and healthy volunteers in terms of correctly identified words and reaction time. Conclusion: Considering the lack of difference between the groups in terms of number of correctly identified words and reaction time, and BA 44's role in recognition and imitation of action and being a part of the mirror neuron system, the significant inverse correlation between PANSS negative score and BA40 can he seen as an effort to compensate for BA44 inadequate activity through BA40

Emphysmatous pyelonephritis: Case report

Amfizematöz piyelonefrit, bağışıklığı baskılanmış (çoğunlukla diyabetik hastalarda) ve üriner obstrüksiyonu olan hastalarda gelişen, hayatı tehdit eden, çok yüksek oranda böbrek kaybı ve mortalite ile ilişkili nekrotizan tipte ciddi bir piyelonefrittir. Yazımızda, kliniğimizde öncelikle konservatif yöntemler ile tedavi edilen fakat sonrasında nefrektomi yapılan amfizematöz piyelonefrit hastasının klinik detaylarını, izlenilen tedavi sürecini ve sürecin sonuçlarını sunmayı hedefledik.Emphysmatous pyelonephritis is a serious pyelonephritis of a necrotizing type associated with life-threatening, very high renal loss and mortality, which is developed in immunocompromised (mostly diabetic patients) and patients with urinary obstruction. In our case, we aimed to present the clinical details of the amphizematous pyelonephritis patient, who was treated primarily with conservative methods in our clinic but then nephrectomy, the treatment process followed and the results of the process

Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder

Patients with Attention Deficit Hyperactivity Disorder (ADHD) suffer not only from inability to focus but also from inability to shift attention for events that trigger their interests. This phenomenon is called ``hyperfocusing{''}. Previous literature about hyperfocusing is scarce and relies mainly on case reports. The study aimed to investigate and compare the severity of hyperfocusing in adult ADHD with and without psycho-stimulant use. ADHD (DSM-IV-TR) patients either psycho-stimulant naive (n = 53) or on psycho-stimulants (n = 79) from two ADHD clinics were recruited. The control group (n = 65) consisted of healthy university students. A socio-demographic form, the Beck Depression Inventory, the Wender-Utah Rating Scale, the Adult ADHD Self- Report Scale and the Hyperfocusing Scale were applied to the participants. There was no difference between total Hyperfocusing Scale and Adult ADHD Self-Report Scale scores of two patient groups, but both have higher scores than controls (p < 0.001). Hyperfocusing is higher in adult ADHD and there was no difference between stimulant-naive patients or patients on stimulants. Hyperfocusing can be defined as a separate dimension of adult ADHD. (C) 2016 Elsevier Ltd. All rights reserved