Noropsikiyatri Arsivi-Archives of Neuropsychiatry最新文献

Objective: Our study aimed to adapt the caregiver version of the Starkstein Apathy Scale (SAS) to Turkish culture and examine its validity and reliability.

Method: 45 patients were diagnosed with Parkinson's Disease (PD), and 40 healthy individuals and their relatives participated in the study. The questions were changed from first-person to third-person statements without any changes. Confirmatory factor analysis was performed for construct validity in the validity analysis. Discriminant validity was performed with a healthy control group. The relationship with the Neuropsychiatric Inventory (NPI) apathy subtest was examined for criterion-dependent validity analysis. In the reliability analysis of the scale, Cronbach's alpha internal consistency analysis was performed. A Receiver Operating Characteristic (ROC) analysis was conducted to determine the cut-off value of the scale.

Results: During the validity and reliability studies, it was observed that items 3 and 13 were incompatible with other factors, reduced the model fit, and were removed from the scale due to low internal consistency. In the analysis with 12 items, a three-factor structure was obtained as 'motivation', 'behavioral', and 'cognitive'. In confirmatory factor analysis, the fit values of the scale were Comparative Fit Index (CFI) =1.000, Normed Fit Index (NFI) = 0.963, and Root Mean Square Error Approximation (RMSEA)= 0.000. Consequently, the study, the Cronbach's alpha coefficient of the scale was found to be 0.84. The discriminant validity analysis found a difference between the clinical and control groups. A positive correlation was found with the NPI Apathy subscale used for criterion-dependent validity. A cut-off value of 11 points with a sensitivity of 71.15% and specificity of 95% was recommended for 12 items.

Conclusion: Our study showed that the SAS Caregiver is a valid and reliable scale for PD patients and can be utilized in clinical and scientific studies.

Inroduction: Communication skills are vital to social functioning. Patients with schizophrenia, who often exhibit impairments in social functioning, experience difficulties in both verbal and nonverbal communication. This study aimed to compare the influence of nonverbal sensitivity and verbal communication disturbance on the social functioning of schizophrenia patients.

Methods: The study included 38 schizophrenia patients (SCH) and 40 healthy controls (HC). Nonverbal and verbal abilities were assessed using the Mini Profile of Nonverbal Sensitivity (Mini-PONS) and the Communication Disturbance Index (CDI), respectively. Social functioning was measured with the Social Functioning Scale (SFS), and symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS).

Results: Schizophrenia patients exhibited significantly lower nonverbal sensitivity and higher verbal communication disturbance compared to healthy controls. Mini-PONS and CDI scores were significantly correlated with SFS scores in the schizophrenia group but not in healthy controls. Regression models revealed that PANSS and Mini-PONS scores significantly predicted social functioning in schizophrenia patients. Furthermore, symptom severity fully mediated the relationship between verbal communication disturbance and social functioning.

Conclusion: Nonverbal communication impairments exert a more pronounced effect on the decline in social functioning among schizophrenia patients. These findings underscore the importance of addressing communication deficits to improve social outcomes in this population.

Introduction: Acute ischemic stroke (AIS) is a common fatal neurological disease worldwide. This study aimed to investigate the prognostic value of the CHA2DS2-VASc score in patients with AIS.

Methods: Two hundred and fifty patients admitted to the emergency department with a diagnosis of AIS without AF were prospectively enrolled in the study.

Results: The CHA2DS2-VASc score, NIHSS score, initial stroke severity (ISS), cerebral infarct volume (CIV), and modified Rankin Scale (mRS) were significantly higher, whereas left ventricular ejection fraction (LVEF) and Barthell index (BI) were significantly lower in the in-hospital mortality (+) group. There was a statistically significant positive correlation of the CHA2DS2-VASc score with NIHSS score (r=0.389; p<0.001), ISS (r=0.417; p<0.001), mRS (r=0.362; p<0.001) and SIV (r=0.214; p<0.001) whereas a significant negative correlation of the CHA2DS2-VASc score with BI (r= -0.371; p<0.001). In multivariable Cox-regression analysis, we found that the CHA2DS2-VASc score (HR: 1.816; 95% CI: 1.209-2.726; p<0.001), congestive heart failure, NIHSS score, and BI were independent predictors of in-hospital mortality. Finally, in the Kaplan-Meier survival analysis, in-hospital mortality was significantly higher in patients with the CHA2DS2-VASc score ≥6 (log-rank p<0.001).

Conclusion: The CHA2DS2-VASc score was established to be an independent predictor of in-hospital mortality and short-term outcomes in AIS patients without AF.

Introduction: Trigeminal neuralgia (TN) is a neuropathic pain syndrome characterized by sudden, severe, and short-lived pain attacks in the facial region. When TN is associated with multiple sclerosis (MS), it may present distinct clinical features. The frequency of refractory TN and treatment responses in MS patients remain controversial in the literature. This study aims to investigate the clinical characteristics of MS-associated TN and assess whether TN is more treatment-resistant in MS patients.

Methods: This retrospective observational study analyzed the clinical and demographic data of patients diagnosed with TN and MS who presented to the Neurology Outpatient Clinic of Ankara Bilkent City Hospital between 2019 and 2025. The study included 36 MS patients with TN and 36 TN patients without MS, matched for age and sex. Variables such as age, sex, disease duration, MS type, Expanded Disability Status Scale (EDSS) score, TN onset age, TN treatment history, and magnetic resonance (MR) imaging findings were recorded. Refractory TN was defined as TN that did not respond to first- and second-line pharmacological treatments and required interventional procedures.

Results: The mean age of MS patients with TN was 51.19±10.78, similar to that of non-MS TN patients (p=0.97). While no significant differences were found in TN clinical characteristics between groups, MRI revealed a higher frequency of TN-associated brainstem lesions in MS patients (p=0.04). The rates of local anesthetic ganglion block and radiofrequency ablation were significantly higher in MS patients (p=0.01, p=0.02). Barrow Neurological Institute Pain Scale (BNI-PS) scores were significantly higher in MS patients (p=0.001), and the prevalence of refractory TN was markedly greater in the MS group (p=0.01). A positive correlation was observed between refractory TN and EDSS scores in MS patients (p=0.002, r=0.482).

Conclusion: This study demonstrates that TN is more resistant to treatment in MS patients, with a higher prevalence of refractory TN. Furthermore, the increased pain severity and greater need for interventional treatments in MS patients suggest that alternative management strategies are required for MS-associated TN. Larger-scale prospective studies are needed to evaluate treatment responses and long-term outcomes in this population.

Introduction: Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) are prevalent mental health conditions, and low self-esteem is considered a vulnerability factor for psychological distress. However, the relationship between self-esteem and symptom severity remains unclear, as evidence regarding the nature of this association is still insufficient. On the other hand, experiential avoidance is recognized as a transdiagnostic variable closely linked to clinical outcomes and individual characteristics, while also being associated with psychological resilience. This study investigates the serial mediating roles of experiential avoidance and psychological resilience in the relationship between self-esteem and the severity of anxiety and depressive symptoms in individuals diagnosed with GAD and MDD.

Methods: The study was conducted with 201 voluntary participants aged between 18 and 65 who had been diagnosed with either GAD (n = 90) or MDD (n = 111) and were being monitored accordingly. Participants were assessed using a sociodemographic and clinical data form prepared by the interviewer, along with the Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Psychological Resilience Scale, Rosenberg Self-Esteem Scale, and the Multidimensional Experiential Avoidance Questionnaire.

Results: The results indicate an indirect relationship between self-esteem and anxiety and depressive symptoms, mediated by experiential avoidance and psychological resilience. This mediation effect was found to be complete for anxiety and partial for depression. Sensitivity analysis confirmed the robustness of the mediation findings.

Conclusion: The findings suggest that individuals diagnosed with GAD and MDD tend to adopt more experiential avoidance strategies in relation to low self-esteem, which in turn leads to a decrease in psychological resilience and an increase in symptom severity. Accordingly, interventions targeting experiential avoidance in the context of self-esteem may contribute to symptom reduction by enhancing psychological resilience.

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a debilitating autoimmune condition that, without timely intervention, can lead to severe disability or even death. Neuromyelitis optica spectrum disorder is an inflammatory disease of the central nervous system characterized by severe attacks such as optic neuritis and transverse myelitis. This study compared the short- and long-term effects of high-dose intravenous methylprednisolone (IVMP) and IVMP+plasma exchange (PLEX) treatment regimens.

Methods: The study evaluated changes in patients' Expanded Disability Status Scale (EDSS) scores over a six-month follow-up period by using different ANOVA and linear regression methods.

Results: Both IVMP and IVMP+PLEX treatments resulted in clinical improvement, with the addition of PLEX showing a more significant reduction in EDSS scores, particularly during the long follow-up period. Moreover, seropositive patients (AQP4/MOG-IgG positive) demonstrated a better response to treatment. Age and baseline EDSS scores were identified as key factors influencing post-treatment improvement.

Conclusion: Our results suggest that the addition of PLEX to IVMP treatment might be suitable especially for severe NMOSD attacks.

Introduction: Body-focused repetitive behaviors (BFRBs) are common but often underdiagnosed and undertreated, with limited understanding of their development. The eight-item Generic Body-Focused Repetitive Behavior Scale-8 (GBS-8) provides a practical, transdiagnostic self-report instrument. The aim of this study was to evaluate the reliability and validity of the Turkish GBS-8 and to examine patterns of BFRBs in a clinical sample of adolescents and young adults.

Method: The sample included 362 adolescents and young adults aged 12-30 years with at least one subclinical or pathological BFRB. Adolescents completed the GBS-8, the Brief Symptom Inventory (BSI), and the Pediatric Quality of Life Inventory (PedsQL), while young adults completed the GBS-8, the BSI, and the Short Form-12 Health Survey (SF-12). Researchers completed the Clinical Global Impression-Severity subscale (CGI-S) to assess the severity of BFRBs.

Results: Participants had a mean age of 17.74 ± 5.04 years, with 78.7% identifying as female. The Turkish GBS-8 showed strong internal consistency and a well-fitting two-factor structure, including symptom severity (α = 0.853), impairment (α=0.779), and the total score (α=0.855). The test-retest reliability analysis further supported the scale's validity and reliability, with a Cronbach's alpha coefficient of 0.851. A total of 50 different BFRB patterns were identified, the most common of which were skin picking, nail biting, lip/cheek biting, and knuckle cracking (8.56%), followed by only nail biting (8.01%) and a combination of nail biting, lip/cheek biting and knuckle cracking (7.18%).

Conclusion: The findings confirm the Turkish validity and reliability of the GBS-8, supporting its utility in clinical settings. This study also highlights the need for increased awareness and tailored interventions to improve BFRBs management.

Objective: High mobility group box-1 (HMGB1) is a non-histone protein that plays a role in neuroinflammation by inducing cytokines. We aimed to compare HMGB1 levels in patients with schizophrenia in both acute exacerbation and remission phases and in healthy controls and to determine whether HMGB1 correlates with symptom severity and C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR).

Methods: The study included 31 schizophrenia patients in remission and 31 schizophrenia patients hospitalised for acute psychotic exacerbation and 30 healthy controls. Serum HMGB1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression Scale (CGI) were used to assess symptom severity.

Results: Serum HMGB1 levels were found to be significantly higher in both the remission group (140.48±63.52 pg/ml) and the acute exacerbation group (125.92±48.71 pg/ml) compared to healthy controls (57.44±13.04 pg/ml) (p<0.05). There was no statistically significant difference in serum HMGB1 levels between patients in remission and patients in acute psychotic exacerbation. There was no correlation between serum HMGB1 levels and severity of symptoms. No significant correlation was found between serum HMGB1 levels and other inflammatory markers. There was a statistically significant negative correlation between serum HMGB1 levels and chlorpromazine-equivalent antipsychotic doses (rs=-0.316, p=0.047).

Conclusions: Our findings suggest that HMGB1 levels are elevated in individuals with schizophrenia, regardless of phase, which may reflect trait-like characteristics of the disorder. However, further research is needed to confirm this. Increased HMGB1 may contribute to schizophrenia pathogenesis through neuroinflammation.

Introduction: Although previous studies have identified associations between insecure attachment styles and nomophobia (NMP), the underlying psychological mechanisms remain underexplored. Grounded in attachment theory, this study investigates the mediating roles of school belongingness and life satisfaction in the relationship between attachment styles and NMP in adolescents.

Methods: The study was conducted with 230 adolescents aged 12 to 18, recruited from a child and adolescent psychiatry outpatient clinic. Participants completed the Attachment Styles Scale in Interpersonal Relationships (ASSIS), Nomophobia Questionnaire (NMP-Q), School Belongingness Scale (SBS), and Life Satisfaction Scale (LSS).

Results: Mediation analysis revealed that anxious attachment was associated with increased NMP through decreased school belongingness (β = 0.036, p = 0.043) and reduced life satisfaction (β = 0.059, p = 0.014). Similarly, secure attachment was associated with lower NMP via higher school belongingness (β = -0.054, p = 0.037) and life satisfaction (β = -0.056, p = 0.013). Avoidant attachment was not significantly associated with NMP or the proposed mediators.

Conclusion: The findings suggest that adolescents' attachment styles influence NMP through their senses of school belongingness and life satisfaction. Designing school-based psychosocial initiatives that cultivate relational anchoring and perceived life coherence may provide a developmentally attuned avenue to buffer NMP risk, particularly in adolescents exhibiting anxious attachment style.

Introduction: Joint attention (JA) is a fundamental aspect of social interaction and a cornerstone of social communication. This study explores factors influencing JA in adults with Autism Spectrum Disorder (ASD) using an interactive, dual eye-tracking paradigm during a tangram puzzle computer gameplay. The JA performance of adults with ASD and a typically developing non-clinical control group (TD-NCC) was assessed alongside partner familiarity (familiar / stranger), partner roles (presenter / operator) and gaze cue (present / absent). Two main objectives were: 1) to evaluate JA through gaze recurrence (GR) in adults with ASD, and 2) to examine the effect of partner familiarity on JA by comparing the performance in the task conducted with either a familiar or an unfamiliar partner (stranger).

Methods: The sample consisted of 42 participants (21 adults with ASD; ages 18-50, 9 females and 12 males and 21 TD-NCC; ages 21-50, 11 females and 10 males). Two non-intrusive desktop eye trackers simultaneously recorded gaze during the JA tangram task. Gaze recurrence was used as an indicator of JA. The gaze cue (present/absent) was a semi-transparent indicator showing where to look. Additionally, to control for potential eye pathophysiology in JA, saccade and anti-saccade tasks were applied to the eye movements of each participant.

Results: The Linear Mixed Effect Model revealed that GR was significantly lower in the ASD group compared to controls. However, the presence of a gaze cue significantly improved the ASD group's GR, especially when interacting with a familiar partner under gaze-cue on conditions.

Conclusion: Understanding factors influencing JA in autism may foster further exploratory studies and significantly impact future research. Eye movements may serve as objective, quantitative, and non-invasive biomarkers for ASD, particularly in interactive gaming contexts.