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

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 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

STATE OF THE ART PSYCHOPHARMACOLOGICAL TREATMENT OPTIONS IN SEASONAL AFFECTIVE DISORDER

Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly

SUICIDE ATTEMPTS IN TURKISH UNIVERSITY STUDENTS: THE ROLE OF COGNITIVE STYLE, HOPELESSNESS, COGNITIVE REACTIVITY, RUMINATION, SELF-ESTEEM, AND PERSONALITY TRAITS

Background: Suicide is one of the major public health problems in young adults. Detecting the risk factors and correlates among university students might help identify students who are under risk and who need early interventions for suicide prevention. Aims: The current study aimed to investigate the cognitive style, self-esteem, hopelessness, rumination, cognitive reactivity, and personality characteristics of Turkish university students, who previously attempted suicide and who did not. Method: A total of 355 university students (34 previous suicide attempters) were recruited for this study, and they completed the Ten-Item Personality Inventory (TIPI), the Ruminative Response Scale (RRS), the Leiden Index of Depression Sensitivity–Revised (LEIDS-R), the Beck Hopelessness Scale (BHS), the Cognitive Style Questionnaire–Short Form (CSQ), the Rosenberg Self-Esteem Scale (RSES), and the Hospital Anxiety and Depression Scale (HADS). Results: Higher RRS, BHS, CSQ scores and lower TIPI-A and RSES scores were significantly associated with a previous suicide attempt. Conclusion: Negative cognitive style, hopelessness, and rumination were significant correlates of a previous suicide attempt. These cognitive factors may be targets in psychotherapy to reduce suicide attempts in college-age individuals

Investigation of medical board reports of disability due to mental health problems

Purpose: This study aims to identify the demographic and clinical data of patients presenting for mental health disability reports from these boards. Material and Methods: In this study, the records of the patients presenting to the medical board for disability due to mental health problems in 2014 were retrospectively investigated. Results: Among the 5670 patients over 18 years who presented to the medical board for disability, 795 (14.2%) of them were assigned a report due to mental health problems. Four hundred ninety one (61.8%) of them were male, and 304 (38.2%) were female. The most frequent reasons for presentation were for benefits related to law number 2022 (35.8%), and for social benefits / home care services (32.8%). The most frequently encountered diagnoses were mental retardation (52.2%), schizophrenia (18.4%), and depression and ndash; dysthymia (7.1%). Three hundred thirteen (39.4%) of the 795 patients with mental health problems were found to be severely disabled, and 510 (64.2%) of the reports were assigned for an indefinite period of time. Conclusion: We think that this report might be helpful for regulations related to disabled people, and might guide adult psychiatric services for patients who present to medical boards for disability due to mental health problems. [Cukurova Med J 2016; 41(2.000): 253-258