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Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis. In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness. The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.

INTRODUCTION: Success in hemodialysis treatment mainly depends on patient’s compliance. At least 50% of patients believed to be non-compliant. This study aims to investigate the factors associated compliance in hemodialysis. Sociodemographic features, social support levels, quality of life, cognitive impairments, comorbid Axis-I disorders and stressors according to DSM-IV, symptom scales, temperament and character features according to Cloninger’s psychobiological model, will be determined and compared between compliant and non-compliant patients. METHODS: Diagnostic interviews of 61 patients -undergoing 4-hour thrice weekly hemodialysis for more than six months- were performed via SCID-I, on the following day of the last session. Standardized Mini Mental State Examination (MMSE), Hamilton Anxiety and Depression Rating Scales, and Temperament and Character Inventory (TCI) were performed. Proportion of ‘inter-dialytic weight gain’ to ‘end session patient weight’ was calculated as percentage and mean of previous 3 months’ data were collected. Patients divided in to two groups (IDWG (%) <3.5: compliant, ≥ 3.5: non-compliant). All the data compared between the two groups. RESULTS: Age, age of hemodialysis onset, MMSE scores, TCI-Harm Avoidance scores were higher; blood pressure levels and TCI-Reward Dependency Total scores were lower in complaints. Psychiatric medication history, family history, stressor rates and current recurrent depression rates were higher in non-complaints. All of the chronic recurrent depressives were non-compliant. DISCUSSION AND CONCLUSION: Being young, early onset of hemodialysis, current recurrent and chronic depression, past history of psychiatric medication, family history of psychiatric illness, stressors, decrease in cognitive functions and high blood pressure levels are the risk factors for noncompliance. Low harm avoidance and high reward dependency are the prominent temperament features of the non-compliant patients. It should be considered that these results may guide interventions to increase treatment compliance in hemodialysis patients.

Introduction: The most prominent characteristic of adult attention deficit hyperactivity disorder (ADHD) is impulsive behavior and deficits in executive functions, which require long-term organization and discipline. This may have serious implications in terms of adherence to treatment among adults living with HIV (PLWH). This study aimed to determine the prevalence of ADHD among non-perinatally infected PLWH and its effect on adherence to antiretroviral treatment (ART) and scheduled appointments. Methodology: The PLWH admitted to our centers between January 2012 and February 2016 were invited to the study. ADHD diagnosis was made according to the novel criteria guided interviews. The first ART interruption for ≥ 6 days per month (≤ 80%) was defined as ‘‘ART-event’’ and the first non-attendance of any scheduled appointment was defined as ‘‘appointment-event’’. Kaplan-Meier plot with a Log-rank test was used for event-free adherence (EFA). Results: Twenty-five patients out of 85 were diagnosed with ADHD (29.4 %) which was significantly higher than the highest percentage reported (7.3 %) for the general population (p < 0.0001). Both ART-event (p = 0.0002) and appointment-event (p = 0.02) were significantly higher among ADHD participants compared to those without. Additionally, both ART-EFA (p = 0.00014) and appointment-EFA (p = 0.023) were significantly shorter among ADHD participants compared to those without. Conclusion: ADHD is significantly higher in adult PLWH and people with ADHD had a significant tendency for non-adherence to ART and follow-up. Screening for ADHD as well as providing treatment when required would be beneficial to achieve and maintain virologic success.

The aim of this study is to evaluate the associations between alcohol-cannabis use and forensic/stressful events with the risk of incident clinical psychosis during follow-up. A community-based sample (n: 2142) was screened for clinical psychosis (schizophrenia and other psychotic disorders, affective disorders with psychotic features) at baseline and follow-up. Thus, incident clinical psychosis cases to develop during follow-up (individuals with no clinical psychosis at the baseline assessment and with clinical psychosis at the follow-up assessment) were detected (n: 27). These cases and the controls who did not report any psychotic symptoms at the follow-up assessment (n: 1691) were compared for exposure to environmental risk factors during follow-up (total n: 1718). Individuals reporting heavy alcohol drinking or cannabis use during follow-up had significantly higher risk of incident clinical psychosis. The monthly frequency of drinking and cannabis use was also associated with the risk. Higher number of stressful life events exposed predicted higher risk of incident clinical psychosis. The risk of incident clinical psychosis was significantly higher in case of coexistence of two risk factors (heavy drinking, cannabis use, ≥3 stressful events), in comparison with the existence of a single risk factor (17.7 vs. 1.6%, p<0.001). Heavy drinking, cannabis use, forensic events and stressful events were associated with the risk of incident clinical psychosis. The coexistence of multiple stressful events and disorders related to abuse of alcohol/cannabis should be considered as a warning for the development of clinical psychosis.

Objectives: Interferon (IFN) treatment has many neuropsychiatric side effects such as depression and anxiety disorder. Although untreated depression is a major contributor to dosage reduction or premature discontinuation of the IFN treatment, it is found that depressive symptoms among patients undergoing hepatitis C virus (HCV) treatment are commonly overlooked during routine clinical interviews. Besides depression, anxiety disorders are shown to affect adherence to pegylated IFN (Peg-IFN) treatment in patients with hepatitis C. Despite the occurrence of neuropsychiatric side effects of IFN treatment being widely reported in patients with hepatitis C, there are few studies studying patients infected with hepatitis B virus (HBV). The aim of this prospective study was to evaluate the incidence and risk factors of depressive and anxiety disorders that occur during Peg-IFN treatment of patients with HBV. Methods: The sample consisted of volunteer patients who were diagnosed with HBV infection and who were decided to receive IFN treatment. During the study period, all consecutive patients with HBV infection and who would have IFN treatment were informed about the study and invited to participate. Thirty-seven chronic hepatitis B (CHB) patients were recruited for the study, but four of them were excluded due to psychiatric diagnosis at the initiation of the treatment. Therefore, the sample consisted of 33 patients with CHB, meeting the inclusion criteria. The participants had psychiatric assessment before the treatment and at 1st, 3rd, 6th, and 12th months. At each visit, the subjects were assessed with Clinical Global Impressions Scale, Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HAM-A). Results: Among the 33 patients with HBV, 22 (66.7%) were men. Mean age was 35.97 ± 10.73 years. While follow-up, 6 patients dropped out from the study. Also, 13 patients were excluded from the study as they developed depression and/or anxiety disorder. Mean baseline HRSD and HAM-A scores were smaller than the following visits' scores. The difference was not statistically significant only for the 12th month assessments. Totally 14 (42.4%) patients developed depression/anxiety disorder during 1 year follow-up. Six (42.86%) of them received the diagnosis at the 1st month, 3 (21.43%) at the 3rd, 4 (28.57%), at 6th months, and 1 (7.14%) at the 12th month. When we compared the patients who developed depression/anxiety disorder with the patients who did not develop any psychiatric disorder, we found that the mean baseline HRSD score (t = 2.303, p = .028) and female percentage (p = .017) were statistically significantly higher in the depression/anxiety disorder group. Conclusions: There is an incidence of 42.4% for depression and/or anxiety disorders during Peg-IFN treatment. Females and patients with subsyndromal depressive symptoms should be referred to a psychiatrist and closely monitored especially for the first three months of the IFN treatment.

Purpose This paper aims to investigate associations between early childhood and current indicators of socioeconomic inequality and the onset (incident), persistence and progression (increase in severity) of psychotic experiences (PEs) in a longitudinal follow-up of a community-based population. Methods Households in the metropolitan area of Izmir, Turkey were contacted in a multistage clustered probability sampling frame, at baseline (T 1 , n  = 4011) and at 6-year follow-up (T 2 , n  = 2185). Both at baseline and follow-up, PEs were assessed using Composite International Diagnostic Interview 2.1. The associations between baseline socioeconomic features and follow-up PEs were analysed using logistic regression models. Indicators of social inequality included income, educational level, current socioeconomic status (SES), social insurance, the area resided, ethnicity, parental educational level, and SES at birth. Results The risk of onset of PEs was significantly higher in lower education, lower SES, and slum-semi-urban areas. The persistence of PEs was significantly associated with the lowest levels of education and current SES, and rural residency. Persistent PEs were significantly and negatively associated with paternal SES at birth. Progression of PEs was significantly higher among respondents with educational achievements lower than university level and lower levels of SES, who have no social insurance and who reside in slum-semi-urban areas. Parental education and paternal SES at birth were not associated with the persistence of PEs. Conclusion Indicators of social inequality (low education, low SES, low income, and poverty in the neighbourhood) were associated with the onset and persistence of PEs and progression along the extended psychosis phenotype. The early indicators seem to have a modest life-long impact on the psychosis phenotype.

Cannabis is the most widely used illegal psychoactive substance worldwide. Although there are clinical studies examining the differences between psychotic symptoms emerging after cannabis use and non-cannabis-related psychotic symptoms, data are limited in the scientific literature. We aimed to investigate the effects of cannabis use on psychotic symptoms and compare the cognitive function differences between the cannabis-user and non-user groups. First-episode psychotic patients were included in the study and divided into two groups based on cannabis use. Participants with cannabis use and without cannabis use were compared in terms of socio-demographic factors, psychotic symptoms, cognitive functions, and childhood trauma. All patients were assessed twice, during recruitment and after treatment for psychotic symptoms. A total of 38 patients comprising of 18 patients with a history of cannabis use and 20 patients without a history of cannabis use were included. There were significant correlations between cannabis use, and living apart from family and family history of substance abuse. Negative psychotic symptoms were higher in the non-user group. The negative psychotic symptoms improved more significantly after treatment in the non-user group. There was a significant correlation between cannabis use and Stroop Color-Word Test scores. Our results give us a chance to argue that psychosis has different features in people with and without a history of cannabis use. These two phenomena could differ in many ways, so different prevention strategies and treatment options should be considered.

Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association between neighbourhood-level social capital and clinical transitions within the spectrum of psychosis. In total, 2175 participants, representative of a community-based population, were assessed twice (6 years apart) to determine their position within an extended psychosis spectrum: no symptoms, subclinical psychotic experiences (PE), clinical PE, PD. A variable representing change between baseline (T1) and follow-up (T2) assessment was constructed. Four dimensions of social capital (informal social control, social disorganisation, social cohesion and trust, cognitive social capital) were assessed at baseline in an independent sample, and the measures were aggregated to the neighbourhood level. Associations between the variable representing psychosis spectrum change from T1 to T2 and the social capital variables were investigated. Lower levels of neighbourhood-level social disorganisation, meaning higher levels of social capital, reduced the risk of clinical PE onset (OR 0.300; z = -2.75; p = 0.006), persistence of clinical PE (OR 0.314; z = -2.36; p = 0.018) and also the transition to PD (OR 0.136; z = -2.12; p = 0.034). The other social capital variables were not associated with changes from T1 to T2. Neighbourhood-level social disorganisation may be associated with the risk of psychosis expression. Whilst replication of this finding is required, it may point to level of social disorganisation as a public health target moderating population psychosis risk.

Background Trans-sexualism is the desire to be a member of the opposite sex during normal somatic sexual development. In this study, we would like to share our endocrinological approach and general clinical features of the patients with gender identity disorder. Patients and methods General and clinical features of 63 patients who were referred to Endocrinology Department between October 2012 and March 2014 were investigated retrospectively. In the beginning of the therapy, and later periodically, the patients were physically examined and their basal hormones and biochemical data were evaluated. Results Forty-eight (76.2%) patients constituted the female-to-male (FtM) group, and 15 (23.8%) patients constituted the male-to-female (MtF) group. The mean age was 25.0±4.6 in the FtM group and 24.9±5.9 in the MtF group. In the FtM group, 28 patients used testosterone preparations as cross-sex hormone, whereas 20 did not. Five (10.4%) patients had already used this preparation before they applied to us. Seven patients underwent mastectomy and four underwent oophorectomy. Penile prosthesis was implanted in one patient with reconstructive surgery. In the MtF group, nine patients used estradiol preparation. In the MtF group, three patients underwent breast implant surgery. Reconstructive surgery or orchiectomy was not performed. Conclusion The cross-sex hormone therapy provides the development of secondary sex characteristics and must also be given as a replacement therapy after gonadectomy.

Purpose There is no report on various patterns of alcohol drinking and related impairment, help-seeking in Turkey. We investigated the 12-month prevalence and correlates of drinking patterns and alcohol use disorders in the general population of Izmir-Turkey, with further analyses on role impairment and help-seeking. Method A multi-stage clustered area probability sample of adult household residents in the Izmir Metropolitan Area was assessed using the Composite International Diagnostic Interview 2.1 ( n   = 4011). Estimation focused on prevalence and correlates of 12-month drinking pattern and DSM-IV alcohol use disorders. The 12-month drinking pattern included groups of non-regular users, regular non-heavy drinkers, regular heavy drinkers, and alcohol abuse disorder and alcohol dependence. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, and were assessed with Short Form-36 for functional impairments. Multinomial logistic regression was used for underlying associations between the covariates and the drinking patterns. Results The rate of lifetime alcohol abstinence was 52.3% while the prevalence of past-year users was 14.8%. The 12-month prevalence estimates of regular heavy drinkers, and alcohol abuse disorder and dependence were 2.5%, 3.2 and 1.6%, respectively. Any of the drinking patterns and alcohol use disorders was associated with male gender, and higher levels of education, monthly income and socioeconomic status. Alcohol dependence was associated with mental health impairment but not with physical impairment. The 12-month rates of help-seeking in alcohol abuse and dependence were 11.6 and 16.5%. Conclusion Although alcohol use disorders are lower than estimates of Western countries, alcohol use constitute a major reason of disability with prominent treatment gap.