OBJECTIVE: Even though quality of life and functioning are topics that are point of interest, they are not assessed adequately in mood disorders. In this study, it is aimed to develop a functioning assessment scale in bipolar disorder. METHOD: Bipolar Disorder Functioning Questionnaire (BDFQ) is developed by the Scientific Section for Mood Disorders of the Psychiatric Association of Turkey. The questionnaire contains 58 items, and consists of eleven subscales: emotional functioning, intellectual functioning, sexual functioning, feelings of stigmatization, social withdrawal, household relations, relations with friends, participation to social activities, daily activities and hobbies, taking initiative and self sufficiency, and occupation. RESULTS: In this study, 252 remitted bipolar patients from 15 centers were included. In addition, thirty subjects without any lifetime psychiatric, neurological or physical disease were recruited. The mean age of the patients was 38.6+/-12.1 and 56%(n=141) were female. The mean duration of the bipolar disorder was 11.9+/-9.2 years, and 91.3% of the patients were diagnosed to have bipolar I disorder. In the reliability analyses, after the exclusion of six items with low reliability coefficients, The Cronbach alpha coefficient was calculated to be 0.91. The item-total scale correlations were between 0.22-0.86. In test-retest reliability, the correlation between the two ratings was high (r=0.82, p<0.0001). In validity analyses, 13 factors were obtained representing 65.1% of the total variance in exploratory factor analysis. In confirmatory factor analysis, 11 domains fit the model with a RMSEA of 0.061. BDFQ significantly correlated with GAF (r=0.428, p<.0001). BDFQ also showed significantly negative correlation with HAM-D (r=-0.541, p<0.0001) and YMRS (r=-0.365, p<0.0001). It discriminated the patients (mean score=111.8+/-15.2) from the healthy subjects (mean score=121.4+/-10.4) well (t=-2.300, p=0.038). CONCLUSION: With the six items excluded, it is suggested that the 52-item BDFQ is a reliable and valid instrument in the assessment of functioning in bipolar disorder.

OBJECTIVE: The aim of this study was to investigate some variables that affect patients' explanation models for their illness and help-seeking behavior. METHODS: Sampling was done between 2002 and 2003 among psychiatric patients who were admitted to university hospital in Malatya. Diagnoses of schizophrenia and schizoaffective disorder were made according to DSM-IV criteria. A semi-structured interview based on a short questionnaire was conducted for collecting patient demographic data, and patient explanatory model for illness and help-seeking behavior. RESULTS: The 88 patients that were evaluated included 50 males and 38 females. The mean age of the patients was 31.22 +/- 9.29 years (range: 16-57 years). In explaining their disease, 46.6% of the patients cited family trouble, 42% their inner problems, 19.3% economic difficulties, and 10.2% cited the consequences of supernatural forces. Among the patients, help-seeking behavior included visiting traditional and religious healers (51.1%), presenting to medical doctors (19.3%), and visiting a psychiatrist (65.9%). CONCLUSION: The study revealed that patients with low-level education were more prone to seek religious solutions and those with high-level education tended to visit a psychiatrist. It has been suggested that psycho-educational programs for patients and families will be very useful in ameliorating the problems created by the disease.

OBJECTIVE: To evaluate the impact of illness progression on the family functioning of patients with schizophrenia, bipolar affective disorder and epilepsy showing chronic relapsing progress and affecting functionality. METHOD: A total of 75 patients who were diagnosed according to DSM-IV criteria as having schizophrenia (n: 25), bipolar affective disorder (n: 25) or epilepsy (n: 25) and their 134 family members were included in the study. A socio-demographical data form was completed by consulting the patient and family members, and a Family Assessment Device (FAD) was used. RESULTS: The general functionality level was low in patients with schizophrenia. Families of patients with bipolar affective disorder had healthier functioning than families of patients with schizophrenia and epilepsy. Subscales of "communication" and "behavioral control" were reported as highly ineffective by the schizophrenia patients. The epilepsy patients have family dysfunction in "behavioral control" and "roles" subscales. The families of bipolar affective disorder patients evaluated their "problem solving" and "general functioning" as problematic. CONCLUSION: The family's experience of disease and adaptation is a dynamic and ongoing process. Our data suggest that chronic psychiatric and neurological diseases may cause some specific difficulties in family functions.

The aim of this prospective study was to investigate the diurnal change in serum nitric oxide (NO) levels in active and remission phases of patients with panic disorder. This study included 15 patients fulfilling the criteria for panic disorder of Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition and 15 healthy controls matched for age and sex. All patients were receiving a selective serotonin reuptake inhibitor at therapeutic doses. The serum nitrite and nitrate levels of subjects were determined at 10:00 a.m. after overnight fasting and at 3:00 p.m. 2 hours after lunch. NO levels of all patients measured in the morning were significantly higher than those of controls. The patients were also divided into active and remission groups according to clinical status and Panic Agoraphobia Scale's cut-off point. There were no statistically significant differences in serum nitrite and nitrate levels of the active group between the 10:00 a.m. and 3:00 p.m. measurements. In contrast, statistically significant differences were found in the serum levels of nitrite (p<0.05) and nitrate (p<0.05) in the remission group. Notably, the afternoon nitrite and nitrate levels of the remission group were higher than those of the morning levels as seen in control subjects. Thus, diurnal variation of NO production is altered in patients with panic disorder but is resumed in the remission phase. The present study suggests that serum NO levels are a good marker for evaluation of panic disorder.

OBJECTIVE: It is known that psychosocial skills training programs increase the efficacy of schizophrenia treatment. The aim of this study was to carry out the Turkish version of two modules of a commonly used program, Social Skills Training (Medication Management and Symptom Management Modules), and to determine its possible benefits. METHOD: The study was carried out at three sites. Fifty schizophrenic patients who were at least literate and who did not have language problems or organic mental diseases, aged 18-60, using antipsychotic agents in a standard dose and in a stable phase were included in the study. Eight training groups were formed. Each group consisted of 5-7 individuals and the study took approximately eight months. The Brief Psychiatric Rating Scale, the Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome, the Drug Treatment Compliance Scale and Pre- and Post-Tests of Social Skills Training were applied to the patients before and after the group education The scores of the rating scales were compared. RESULTS: Thirty-eight (76%) patients completed the study. The mean age of the patients was 32 +/- 7, 84% were men, 58% had received less than 11 years, of education 84% had never married, and 97% were living with their families. The mean age of illness onset was 20 +/- 5 years, and the mean duration of the illness was 12 +/- 7 years. At the end of the study, the Brief Psychiatric Rating Scale scores (baseline 42.0, after the training 37.1, p<0.02), and the Quality of Life Scale scores (baseline 67.5, after the training 75.3, p<0.01) were significantly changed. The level of knowledge of the patients about the medication and symptoms of schizophrenia increased 20.6%. Drug treatment compliance had also increased by the end of the study. CONCLUSION: The results show that this program contributed to the treatment compliance and treatment efficacy in schizophrenia. Increased treatment efficacy might have played a role in increasing of the quality of life a long with the group milieu. It may be concluded that this social skills training program, which did not encounter any problems in application, may contribute significantly to the treatment of schizophrenia.

There is great evidence in recent years that oxygen free radicals play an important role in the pathophysiology of schizophrenia. The present study was performed to assess the changes in plasma nitric oxide (NO) and thiobarbituric acid-reactive substances (TBARS) levels, and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and xanthine oxidase (XO) activities in schizophrenic patients compared to age- and sex-matched normal controls. A hundred patients with schizophrenia and 51 healthy volunteers were included in the study. XO, SOD, and GSH-Px activities as well as NO and TBARS levels were estimated by standard biochemical techniques in the plasma of normal healthy controls and schizophrenia patients. In schizophrenia, increased plasma XO activity (P <.0001) and NO levels (P <.0001), decreased SOD activity (P <.0001), and unchanged GSH-Px activity were detected compared to control group. Plasma TBARS levels were increased in schizophrenic patients (P <.01), especially in the residual subtype. TBARS levels in nonsmoker schizophrenic patients were found to be higher than nonsmoker controls. Although TBARS levels in both patients and controls were found to be higher in smokers as compared to nonsmokers, it was not statistically significant. No effects of duration of the illness, gender, and low and high dose of daily neuroleptic treatment equivalent to chlorpromazine on oxidant and antioxidant parameters were observed. Because the dose and the duration of treatment with drugs have no influence on the results, it can be interpreted that the findings are more likely to be related mainly to the underlying disease. These findings indicated a possible role of increased oxidative stress and diminished enzymatic antioxidants, both of which may be relevant to the pathophysiology of schizophrenia. On the other hand, increased NO production by nitric oxide synthetases (NOSs) suggests a possible role of NO in the pathophysiological process of schizophrenia. These findings may also suggest some clues for the new treatment strategies with antioxidants and NO synthase (NOS) inhibitors in schizophrenia.

OBJECTIVE: Previous estimates of the prevalence of seasonal affective disorder (SAD) in community-based samples generally originated from western countries. We report prevalence rates in eight groups from four latitudes in Turkey. METHOD: Seasonal Pattern Assessment Questionnaire (SPAQ) was distributed to the community-based samples from eight different locations at four latitudes in Turkey. The prevalence rates of winter SAD and subsyndromal SAD (S-SAD) were estimated for the four groups at the same latitudes by using SPAQ responses. RESULTS: We distributed 3229 SPAQs, had an overall response rate of 54.16% and 1749 SPAQs were included in the analyses. Seasonality was reported as a problem by 549 subjects (31.57%) of our 1749 respondents. Prevalence of winter SAD and S-SAD are estimated as 4.86 and 8.35%, respectively, for the whole group. Prevalence rates were determined for each center and for four latitudes (two centers at the same latitude were grouped as one). In Adana-Gaziantep (lt. 37), Izmir-Elaziğ (lt. 38), Eskişehir-Ankara (lt. 39) and Trabzon-Edirne (lt. 41), the prevalence rates for winter SAD were 6.66, 2.25, 8.00 and 3.76%, respectively. CONCLUSIONS: Our prevalence estimates of winter SAD are similar to those found in previous community-based studies at the same latitudes; no correlation was found between latitude and prevalence of winter SAD, which could be related to the sampling methodology or to the fact that there were only 5 degrees of difference between the latitudes.