Adem Balikci

Plasma asymmetric dimethylarginine (ADMA) concentrations in patients with first and multiple episode schizophrenia

An increasing number of reports in the literature indicate that asymmetric dimethylarginine (ADMA) regulates nitric oxide generation in numerous disease states. ADMA has been less studied in psychiatric disorders. The purpose of this study was to determine plasma ADMA concentrations in patients with schizophrenia compared to healthy controls. The study was conducted in 49 male patients with schizophrenia and 30 healthy male control subjects. The patient group was 24 first episode and 25 multiple episode schizophrenia participants. All schizophrenic patients were administered the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms (SAPS) and the Brief Psychiatric Rating Scale. Measurement of plasma concentrations of ADMA was accomplished by HPLC. There was a significant increase in the plasma ADMA concentrations in patients with schizophrenia when compared to healthy controls. There were no significant correlations between the plasma concentrations of ADMA and scores of psychiatric rating scales. In the multiple episode schizophrenia subgroup, the mean plasma ADMA concentration was significantly higher than in the first episode schizophrenia subgroup. The study indicate that plasma ADMA concentrations in patients with schizophrenia are elevated.

Quality of sexual life in men with obstructive sleep apnoea

The study investigated the quality of sexual life of male obstructive sleep apnoea patients. Apnoea and non-apnoea participants were assessed with Golombok Rust Inventory of Sexual Satisfaction (GRISS) and Structured Clinical Interview for DSM-IV (SCID) before the sleep test. Folicule Stimulating Hormone (FSH), Luteinising Hormone (LH), prolactin, testosterone and oestrogen levels were also evaluated. The apnoea group had a higher BMI and lower LH and testosterone levels than the non-apnoea group. There were no differences between the apnoea, non-apnoea groups and within the apnoea groups (mild, moderate and high apnoea) in terms of sexual satisfaction. Although there was a change in the hormonal levels of obstructive sleep apnoea patients, the sexual life of apnoea patients was not affected at the clinical level.

Serum haptoglobin levels in patients with melancholic and nonmelancholic major depression

BACKGROUND Major depression (MD) is accompanied by systemic immune activation or an inflammatory response with the involvement of phagocytic cells, T cell activation, B cell proliferation, and an acute phase response with increased levels of positive and decreased levels of negative acute-phase proteins. In this study, we aimed to determine any differences in serum haptoglobin (Hp) concentrations among patients with melancholic and nonmelancholic MD and the healthy controls. METHODS This study involved 125 male patients who were admitted to the Department of Psychiatry, Gulhane Military Medical Academy (GMMA), in Ankara, Turkey. They were diagnosed with MD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and agreed to participate in the study. The melancholic group consisted of 37 patients and the nonmelancholic group had 45 patients. A healthy control group of 40 subjects was selected from the staff of GMMA. These subjects had not had any lifetime psychiatric diagnosis or psychiatric treatment in their medical histories. Peripheral venous blood samples were obtained from the patients and the control group for a complete blood count, routine biochemistry, and the detection of serum Hp levels. RESULTS There was no statistically significant difference among the melancholic MD, the nonmelancholic MD, and the healthy control groups in terms of age, level of education, and gender. Serum Hp concentrations are significantly higher in melancholic patients as compared with non-melancholic depressed patients and controls. However, there was no statistically significant difference between the nonmelancholic MD and the control group in terms of Hp concentrations. CONCLUSION The results of this study are important in terms of showing different serum Hp concentrations in patients with melancholic and nonmelancholic MD.

Role of CRP, TNF-a, and IGF-1 in Delirium Pathophysiology

INTRODUCTION Delirium is a common and life-threatening neuropsychiatric syndrome. Diagnosing delirium can be challenging, which increases mortality and mortality rates and health care costs. The biologic model of delirium is not definite yet, but evidence supports a cholinergic deficiency model. Delirium may be the result of processes and drugs that trespass a compromised blood-brain barrier. We aimed to evaluate the possible diagnostic utilization and the role of certain biomarkers, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and insulin like growth factor-1 (IGF-1), in delirium etiology. METHODS A total of 93 inpatients that planned to undergo cardiovascular surgery were informed; 35 of them completed the study. Medical history and current cognitive status were evaluated pre-operatively. Participants were followed using Delirium Rating Scale-Revised-98 Turkish (DRS-R98-T) for delirium symptoms, and blood samples were collected post-operatively. RESULTS Delirium was developed more in participants who had worse pre-operative cognitive status. Also, low pre-operative IGF-1 levels were detected in the delirium group. Pre-operative CRP and TNF-α levels were not different between groups. CONCLUSION Low IGF-1 levels can be used to predict delirium after surgery. However, the complex nature of cytokines and delirium itself make it difficult to utilize cytokines to predict delirium instead of psychometric tools.

Decreased cerebral vasomotor reactivity in patients with obstructive sleep apnea syndrome

OBJECTIVE In obstructive sleep apnea syndrome (OSAS), any of the activated neural, vascular, hemodynamic, metabolic, inflammatory, and thrombotic mechanisms may be related to increased cerebrovascular disease and risk of death; however, the possible pathophysiological process between obstructive sleep apnea syndrome and stroke has not been clearly explained. We hypothesize that alterations in vasomotor reactivity in patients may be responsible for their altered cerebral blood flow, and may contribute to the increased risk of ischemic stroke. METHODS A total of 30 untreated patients with severe obstructive sleep apnea and 26 control subjects were included in the study. The mean blood flow velocity and breath holding index were measured in middle cerebral artery bilaterally in both patient and control groups by using transcranial Doppler ultrasound. We compared the values between two groups. RESULTS The mean blood flow velocity and breath holding indexes were significantly decreased in the patient group when compared with the control group. There were no correlations between cerebral hemodynamic parameters and polysomnographic findings in patients. CONCLUSION Our findings suggest that there was a deteriorated vasodilator response to hypercapnia in patients with OSAS. This deterioration may stem from chemoreceptors or endothelial damages that lead to vascular relaxation and vasodilatation in cerebrovascular circulation. This impaired cerebral vascular regulation may contribute to the increased risk of stroke in patients with OSAS.

Plasma Indolamine 2,3 dioxygenase and serum neopterin levels in patients with first episode major depressive disorder and recurrent major depressive disorder

Objective: The aims of this study were to determine whether the plasma Indolamine 2,3 dioxygenase and neopterin levels in patients with major depression differ from a healthy control group and to investigate the relationship between previous major depression episodes and plasma indolamine 2,3 dioxygenase and serum neopterin levels. Methods: Thirty eight first episode major depression patients, sixty four recurrent major depression patients and forty one healthy control participant included the study. Plasma indolamine 2,3 dioxygenase and serum neopterin levels compared in these three groups. Results: Plasma indolamine 2,3 dioxygenase and serum neopterin levels in recurrent major depression group were statistically higher than first episode major depression and healthy control group. There was a positive correlation between plasma IDO levels and number of depressive episodes in major depression group (rho=0.36, p<0.001). Conclusion: According to these findings previous major depression episodes can promote response of the immune system associated with proinflamatuar cytokine activity. This sensitizing effect of previous depressive episodes may increase the recurrence risk of depression.

Cortical Excitability and Agressive Behavior in Post-Traumatic Stress Disorder

INTRODUCTION Hyperarousal and alertness play an important role in the clinical presentation of Post-traumatic stress disorder (PTSD). Strenuous effort has been made to shed light on the mechanisms that cause these symptoms of patients. Based on the claim that there is a relationship between some subtypes of hyperarousal symptoms and aggression in patients with PTSD, we aimed to examine the relationship between electrophysiological measurements that was measured through transcranial magnetic stimulation (TMS) and aggression scale scores of PTSD patients in this study. METHODS The study included 37 patients with a diagnosis of PTSD according to DSM-IV criteria and 25 healthy volunteers. Electrophysiological measurements of participants were made with TMS. The Buss Perry Aggression Questionnaires was administered to patients and control group. RESULTS In the patient group, a positive correlation was found between scores of aggression and arousal symptoms. Motor excitability threshold, one of TMS measurements, which is a sign of cortical excitability, was significantly lower in the patient group than the control group. There was a negative correlation between aggression scale scores and the parameters of motor excitability threshold and cortical silent period which both shows cortical excitability of the patients. CONCLUSION We concluded that there was an increase in cortical excitability in PTSD patients and we suggest that this increase might be associated with hyperarousal symptoms and aggressive behavior.

Relation Between Serum Cortisol Levels and Symptoms in Posttraumatic Stress Disorder (Ptsd)

Objective Hipotalamoptuiter-adrenal axis dysfunctions (HPA) are thought to play an important role in PTSD. HPA axis responds to stress with secretion of glucocorticoids (i.e., cortisol), which is vital in maintaining biological homeostasis and adaptation (allostasis) to chronic stress. In this study, we aimed that the relationship between PTSD symptoms and serum cortisol levels were investigated. Methods Forty-eight (N=48) males inpatients with PTSD diagnosed according to the DSM-IV criteria were enrolled to the study. The mean±SD of their age was 26.6±5.8 years. The rates of patients were related with combat and other traumatic events: 83.3% and 16.7% respectively. The mean duration±SD of their illness was 17.9±20.1 months (median 8 months). The severity of PTSD symptoms was evaluated by clinician administered PTSD scale (CAPS) I, II and impact of the event scale (IES). Morning and evening serum cortisol levels were obtained before and after the applying dexamethasone suppression test. Results The rate of comorbidity in PTSD was 66.6%. Co-morbidity increases the severity of PTSD, but the serum cortisol levels were not associated with comorbidity. The negative correlations were determined between the basal (morning) serum cortisol levels and severity of symptoms CAPS II intrusive and avoidance symptoms (r=-0.31, p=0.04), (r=-0.30, p=0.05); evening serum cortisol level and IES score (r=-0.30, p=0.05); morning serum cortisol after administration of dexamethasone and CAPS I intrusive symptom severity (r=-0.37, p=0.01). Conclusion We found that serum cortisol levels were negatively related to intrusive and avoidance symptoms of PTSD. These data show specificity of abnormal HPA axis dysfunctions in PTSD.

Depressive symptoms in first episode schizophrenia patients under treatment: one-year follow-up comparison of classical and atypical antipsychotics -

Objective: Depression is an important syndrome occurring frequently during the course of schizophrenia. In patients using atypical antipsychotics in the treatment of schizophrenia, depressive symptoms are expected at a lower rate. In this retrospective study, evaluation of depressive symptoms in patients who were monitored for one year with first-episode schizophrenia using atypical or conventional antipsychotic treatment was intended. Methods: The study was carried out by examining the records of 93 patients with first-episode schizophrenia. The data of the Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale and the Calgary Depression Scale were used for evaluation. Classical antipsychotics (n=21), olanzapine (n=28), risperidone (n=25) or quetiapine (n=19) were found to be used in the treatment of subjects. According to clinical status, the subjects were invited to the controls at intervals not longer than two months. The above scales were applied to subjects at each control to measure the depressive symptoms and to determine the relationship of those with clinical variables. Results: The classic antipsychotic group (57.1%) showed more significantly severe depressive symptoms (HAM-D score≥17) than the atypical antipsychotic group (31.9%). The rate of depression and depressive symptoms were similar among the subjects used atypical antipsychotic agents. Conclusion: Possibly depending on their mechanism of action and the effects on negative symptoms of patients with schizophrenia, the atypical antipsychotic drugs showed lower rate of depression compared to conventional antipsychotics.

Polikistik over sendromu olan hastalarda depresyon, anksiyete ve öfke

Introduction: Polycystic Ovary Syndrome (PCOS) is a syndrome of heterogeneous nature, affecting multiple systems, particularly the endocrine system. We propose to investigate the possible relationships among hormonal changes, levels of anxiety, depression, and anger in patients with PCOS. Method: Forty-four female patients with PCOS and 44 body mass index (BMI )-matched healthy women participated in this study. We measured the sociodemographic features, some serum hormonal levels (insulin, gonadotropins, prolactin, dehydroepiandrosterone sulfate (DHEAS), thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), 17 OH-progesterone, and total and free testosterone), and some other biochemical parameters of the participants. Also, all participants completed the Trait Anger-Anger Expression Scale (STAS), Beck Depression, and Beck Anxiety Inventories. We evaluated the psychiatric scale scores obtained from PCOS patients and control subjects. We used the independentsamples t-test for parametric data to evaluate normal distribution, and Mann-Whitney U-test was used for both abnormally distributed and nonparametric data. We used Pearson correlation analysis to evaluate the potential connection between the two groups’ data. Results: The mean ages of the patients with PCOS and control subjects who participated in this study were 27.3±5.6 and 27.4±6.1 years, respectively. The measures of BMI, insulin, luteinizing hormone (LH), DHEAS, and total testosterone serum levels in the patient group were significantly higher than in the control group (p<0.05). There was a statistically significant positive correlation between Beck anxiety scores and serum DHEAS levels (Pearson r=0.4366, P=0.0001). We found significant differences between the two groups in terms of trait anger, anger control, outward and inward anger, anxiety level, and depression scores (P<0.05). Conclusion: Anxiety symptoms indicate a stronger relationship compared to depression with DHEAS serum levels via the autonomic nervous system, considering the gammaaminobutyric acid (GABA)-antagonistic effect of DHEAS. Obesity, hirsutism, and infertility may reduce self-confidence and create depressive symptoms in patients with PCOS. In addition, changes in hormonal levels may lead to anxiety directly. Possibly, depressive symptoms are a secondary reflection of these changes. (Archives of Neuropsychiatry 2014; 51: 328-333)