Ahmet Ünal

Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study.

Abstract Objective. Refugees have had major challenges to meet their health care needs throughout history especially in war zones and natural disaster times. The health care needs of Syrian refugees have been becoming an increasingly important issue. We aimed to examine the prevalence of post-traumatic stress disorder (PTSD) and explore its relation with various socioeconomic variables among Syrian refugees, who sought asylum in Turkey. Methods. This cross-sectional study was conducted in a tent city. Sample size calculation yielded 352 and the participants of the study were determined randomly. Experienced and native Arabic speaking, psychiatrist evaluated the participants. Results. The frequency of PTSD was 33.5%. Through the binary logistic regression analysis, we calculated that the probability of having PTSD among Syrian refugees in our sample was 71%, if they had the following features: with female gender; being diagnosed with psychiatric disorder in the past; having a family history of psychiatric disorder; and experiencing 2 or more traumas. Conclusions. The findings of our study suggest that PTSD among Syrian refugees in Turkey might be an important mental health issue in refugee camps especially among female refugees, who were exposed to 2 or more traumatic events and had a personal or family history of psychiatric disorder.

Is increased red cell distribution width (RDW) indicating the inflammation in Alzheimer's disease (AD)?

Increasing evidence indicates that inflammation has a substantial role in the pathogenesis and progression of AD. RDW, a measure of heterogeneity in the size of circulating erythrocytes, is associated with inflammatory markers in many numerous diseases. Present study was undertaken to assess the interrelationships between RDW and AD. A total of 197 patients with AD (male/female: 96/101, mean age 76.2 ± 6.9) and 133 patients as controls with normal cognitive function (male/female: 72/61, mean age 71.68 ± 5.3) were enrolled in this cross-sectional study. RDW values of all participants were measured. Mini-Mental State Examination (MMSE) and clock drawing tests were performed for cognitive assessment. DSM-IV and NINCDS-ADRDA criteria were used for diagnosis of AD. The mean RDW values were significantly higher in AD group (13.93 ± 1.1 vs. 13.24 ± 1.2; p<0.001) and also a negative moderate correlation between RDW and MMSE was identified (r: -0.453; p<0.001). After adjusting for confounders, RDW has the strongest association with AD (odd ratio (OR) 1.51, CI=1.10-2.07). In present study RDW levels were significantly increased in patients with AD. Whereas elevated RDW value is usually considered as a novel biomarker of inflammation, the results of our study may support the role of inflammation in pathophysiology of AD. Furthermore the correlation of RDW with poorer cognition status suggests that it may be used as a marker of AD severity.

Reduced total antioxidant level and increased oxidative stress in patients with deficit schizophrenia: A preliminary study

INTRODUCTION Deficit schizophrenia (DS) is defined for identifying a relatively homogeneous subgroup of patients with diagnosis of schizophrenia, characterized by the presence of primary and enduring negative symptoms. There have been several studies which investigated the status of oxidative stress and total antioxidant level in patients with schizophrenia. However, there is not any study which researched differences between DS and nondeficit schizophrenia (NDS) in terms of status of oxidative stress and antioxidant level. We hypothesized that patients with DS would have different status of oxidative stress and antioxidant levels compared with patients with NDS. METHODS Twenty-three patients with DS, 42 patients with NDS and 31 age, sex and smoking status matched healthy controls (HC) were included to study. Five milliliters of blood was drawn from control subjects and patients for assessing total antioxidant potential (TAOP) and total peroxide levels (TPEROX). The ratio of TPEROX to TAOP is referred as oxidative stress index (OSI). RESULTS We noticed that serum TAOP level was significantly lower in DS group compared with NDS and HC groups. The OSI was also found to be higher in DS group compared with NDS and HC groups. Furthermore, serum TAOP level and status of OSI were similar between NDS and HC groups. CONCLUSION Our study is the first to demonstrate differences between DS and NDS in terms of status of oxidative stress and serum total antioxidant level. We suggest that our study represents novel and important results in terms of supporting provides and hypothesis which considered DS as a different disease entity with respect to NDS. Further studies are needed for investigating the status of antioxidants and oxidative stress and their clinical implications in deficit schizophrenia.

Increased oxidative stress and oxidative DNA damage in non-remission schizophrenia patients

Increasing evidence shows that oxidative stress plays a role in the pathophysiology of schizophrenia. But there is not any study which examines the effects of oxidative stress on DNA in schizophrenia patients. Therefore we aimed to assess the oxidative stress levels and oxidative DNA damage in schizophrenia patients with and without symptomatic remission. A total of 64 schizophrenia patients (38 with symptomatic remission and 26 without symptomatic remission) and 80 healthy volunteers were included in the study. 8-hydroxydeoxyguanosine (8-OHdG), total oxidant status (TOS) and total antioxidant status (TAS) were measured in plasma. TOS, oxidative stress index (OSI) and 8-OHdG levels were significantly higher in non-remission schizophrenic (Non-R-Sch) patients than in the controls. TOS and OSI levels were significantly higher in remission schizophrenic (R-Sch) patients than in the controls. TAS level were significantly lower and TOS and OSI levels were significantly higher in R-Sch patients than in Non-R-Sch patients. Despite the ongoing oxidative stress in patients with both R-Sch and Non-R-Sch, oxidative DNA damage was higher in only Non-R-Sch patients compared to controls. It is suggested that oxidative stress can cause the disease via DNA damage, and oxidative stress plays a role in schizophrenia through oxidative DNA damage.

Electroconvulsive therapy in pregnant patients

OBJECTIVES In this study, the aim was to evaluate the clinical characteristics of patients that received electroconvulsive therapy (ECT) during pregnancy due to psychiatric disorders, evaluate the safety and efficacy of ECT in pregnant women, and evaluate the overall status of mothers and babies during the postpartum period. METHODS The study included 33 patients who were admitted as inpatients with the indication of ECT due to pregnancy and concurrent psychiatric disorders. RESULTS Upon ECT administration, a complete response to treatment was seen in 84.21% of patients with major depression (n=16), a partial response to treatment in 15.78% of patients (n=3), a complete response to treatment in 91.66% of patients with bipolar disorder (n=11), a partial response to treatment in 8.33% of the patients(n=1), and a full response to treatment in 50% of patients with schizophrenia (n=1) and a partial response to treatment in 50% of patients with schizophrenia (n=1) were obtained. We had after birth information of 27 infants from total 33. It was learned that two of them had disease, one was stillbirth and 24 of them did not have any health problems. CONCLUSIONS ECT administration during pregnancy to treat psychiatric disorders was found to be an effective treatment method. No risk of preterm birth in mothers treated with ECT during pregnancy was detected.

Effective treatment of catatonia by combination of benzodiazepine and electroconvulsive therapy.

Objective Catatonia, a motor dysregulation syndrome, can emerge in numerous psychiatric disorders, mainly in schizophrenia and mood disorders, and metabolic and endocrine disorders such as infections, toxic states, epilepsy, and traumatic brain injury. In our study, we aimed to investigate demographic, clinical, and treatment-related characteristics of catatonic patients managed in our inpatient clinic. Methods The medical records of 57 patients diagnosed to have catatonia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the inpatient psychiatry clinic of the Gaziantep University School of Medicine between 1 January, 2003, and 31 December, 2011, were retrospectively reviewed. Results In patients with catatonia, mood disorders (63.2%) were found to be the most common underlying or primary disease, whereas mutism (47.4%) was found to be the most common catatonic symptom. There was a comorbid medical condition in 9 patients (15.8%). Patients underwent an average of 9.00 electroconvulsive therapy (ECT) sessions. Among 57 patients with catatonia, catatonic symptoms were resolved in 57 patients (100%) by benzodiazepine and ECT. Conclusions In our study, full recovery was achieved in catatonia by benzodiazepine plus ECT combination. As a result, we recommend combined ECT and benzodiazepine for catatonia.

Are oxidative stress markers useful to distinguish schizoaffective disorder from schizophrenia and bipolar disorder

Objective Schizoaffective disorder is a disease with both affective and psychotic symptoms. In this study, we aimed to compare oxidative metabolism markers of schizoaffective disorder, bipolar disorder and schizophrenic patients. Furthermore, we also aimed to investigate whether schizoaffective disorder could be differentiated from schizophrenia and bipolar disorder in terms of oxidative metabolism. Methods Total oxidant status (TOS) and total antioxidant status (TAS) were measured in the blood samples that were collected from schizoaffective patients (n = 30), bipolar disorder patients (n = 30) and schizophrenic patients (n = 30). Oxidative stress index (OSI) was calculated by dividing TOS by TAS. Results TOS and OSI were found to be higher in patients with schizoaffective disorder compared with those in schizophrenia and bipolar disorder patients. TAS was not significantly different between the groups. Conclusion Schizoaffective disorder was found to be different from bipolar disorder and schizophrenia in terms of oxidative parameters. This result may indicate that schizoaffective disorder could differ from bipolar disorder and schizophrenia in terms of biochemical parameters. Increased TOS levels observed in schizoaffective disorder may suggest poor clinical course and may be an indicator of poor prognosis.

İki uçlu bozukluk’ta tedavi uyumu

Amaç: İki Uçlu Bozukluk (İUB), kronik seyri nedeniyle sürdürüm tedavisini gerektiren ve bu yüzden etkin tedavi için yüksek düzeyde hasta uyumunun zorunlu olduğu bir hastalıktır. İUB’de tedaviye uyumsuzluk, nüks ve yinelemenin ana sebebi olarak düşünülür. Bu çalışmada, en az bir yıl öncesinden psikiyatri polikliniğinde kaydı olan ötimik iki uçlu hastalarda: son bir ayda ilaç tedavisine uyum düzeyinin, uyumu etkileyen sosyodemografik, klinik özelliklerin ve son bir yıl içerisindeki takip muayene sayıları ile tedavi uyumu arasındaki ilişkinin araştırılmasını amaçladık. Yöntem: Malatya Devlet Hastanesi Psikiyatri Polikliği’ne başvuran 18 yaşından büyük, DSM-IV’e göre İUB tanısı konulmuş ve en az bir yıldır bu tanı ile poliklinik takibinde olan ötimik, 147 hasta çalışmaya alındı. 01-28 Şubat 2011 tarihleri arasında takip muayenesine gelen hastaların eşzamanlı olarak hastane bilgisayar kayıtlarına bakıldı. 01 Şubat 2010’dan itibaren bilgisayar kaydı olanlar çalışmaya alındı ve kaç defa takip muayenesine geldiği kayıtlardan tespit edildi. Çalışmaya aldığımız hastaların demografik değişkenlerini, klinik özelliklerini, hastalığı ve tedavisi ile ilgili tutumlarını içeren bilgiler hazırladığımız Veri Toplama Formu’na kaydedildi. Hastalar, son bir ay içerisinde ilaç kullanmadığı ya da düzensiz kullandığı gün sayısı 7’den az olanlar tedaviye uyumlu, 7’den fazla olanlar tedaviye uyumsuz olarak iki gruba ayrıldı. Verilerin istatistiksel analizi SPSS 16.0 ile yapıldı. Tedaviye uyumlu ve uyumsuz grupların verileri karşılaştırıldı. Bulgular: Hastaların, 108’i (%73.5) tedaviye uyumlu, 39’u (%26.5) tedaviye uyumsuzdu. Eğitim düzeyi (8 yıl temel alındı) uyumlu grupta daha yüksekti (p<0.001). Uyumlu grupta hastanede yatış oranı, uyumsuz gruba göre daha düşüktü (p<0.05). Uyumlu grupta son bir yılda takip muayenelerine devam etme oranı (p<0.001) ve hastalığına karşı içgörü oranı daha yüksekti (p<0.001). Her iki grup arasında şu anda kullandığı ilaç veya ilaç kombinasyonları açısından fark yoktu (p>0.05). Uyumlu grup, hastalığı ve tedavisi hakkında uyumsuz gruba göre daha fazla bilgilendirildiğini düşünüyordu (p<0.001). Uyumsuz grupta, tedaviden fayda görmediğini düşünerek (p<0.05) ve iyileştiğini düşünerek ilacı bırakma oranı daha yüksekti (p<0.001). Ayrıca, iyileştiğini düşünerek tedaviyi bırakma oranı tedaviden fayda görmediğini düşünerek ilaç bırakma oranına göre daha yüksekti (p=0.04, χ=8.64). İlaç kullanmaktan hoşnutsuz olma uyumsuz grupta daha yüksekti (p<0.05) Sonuç: Bu araştırmada, düşük eğitim düzeyi, hastalıkla ilgili yetersiz bilgilendiğini düşünme, içgörü eksikliği, tedaviden hoşnutsuz olma gibi veriler tedaviye uyumsuz grupta daha fazla bulundu. Ayrıca, tedaviye devam etmemenin en önemli sebebinin iyileştiğini düşünerek ilacı bırakma olduğu saptandı.

Evaluation of oxidative metabolism and oxidative DNA damage in patients with obsessive–compulsive disorder

There are limited published data about the role of oxidative stress in the pathophysiology of obsessive–compulsive disorder (OCD). In addition, oxidative stress and oxidative DNA damage have not been investigated together in OCD. In this study, we aimed to evaluate oxidative stress and oxidative DNA damage in patients with OCD.

Anxiety Score as a Risk Factor for Radial Artery Vasospasm During Radial Interventions A Pilot Study

We determined the role of anxiety level on radial artery spasm during transradial coronary angiography. Eighty-one patients who had an indication for coronary angiography were enrolled. Radial artery vasospasm was determined by addressing 5 signs: persistent forearm pain, pain response to catheter manipulation, pain response to sheath withdrawal, difficult catheter manipulation after being “trapped” by the radial artery, and considerable resistance on withdrawal of sheath. Radial spasm defined as at least 2 of the 5 signs. The Hamilton Anxiety scale questionnaire was used to determine the level of anxiety. Vasospasm was observed in 19.1% of the patients. Anxiety score was significantly higher in women (11.1 ± 7.2 vs 17.6 ± 7.3; P < .001). Vasospasm was significantly correlated with female sex (P < .001, r = .43) and anxiety score (P = .007, r = .29). Female sex was associated with higher anxiety scores (P < .001, r = .43). In conclusion, higher anxiety scores and female sex are important risk factors for radial artery vasospasm.