Aylin Ertekin Yazıcı

Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale.

Objectives: The objective of this study was to test whether a Turkish version of the Neck Pain and Disability Scale retains its reliability and validity of the original English version. Methods: Sixty-one patients with chronic neck pain were enrolled in the study. The Neck Pain and Disability Scale (NPDS), the Pain Disability Index (PDI) and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbachs alpha and item-total correlation. Validity was examined by correlating the NPDS scores to the Visual Analogue Scale (VAS), PDI and HADS scores. Results: Cronbachs alpha value for NPDS was found to be 0.86 and this was statistically significant (p < 0.0001). The item-total correlations of NPDS varied between 0.08 and 0.69. The cross-sectional construct validity coefficients were 0.51 for PDI, 0.45 for VAS, 0.35 and 0.33 for Hospital Anxiety and Depression Scales. Conclusion: Despite its major limitations, our results seem to support previous findings of the English and French versions of the Neck Pain and Disability Scale, indicating that this functional scale is valid and reliable.

Effects of fluoxetine and venlafaxine on serum brain derived neurotrophic factor levels in depressed patients

BACKGROUND Several studies demonstrated that depressed patients had low serum BDNF levels which correlated with the severity of their depression, and antidepressant treatment increases levels of serum BDNF in depressed patients. It was speculated that agents acting on both noradrenergic and serotonergic transporters might have a greater influence on BDNF levels. The aim of our study was to determine effects of venlafaxine vs. fluoxetine on serum BDNF levels in depressive patients. METHODS Forty-three patients diagnosed as major depressive disorder according to DSM-IV are included in the study. Forty-three patients were randomized to take fluoxetine (22 cases) or venlafaxine (21 cases). Serum levels of BDNF were measured by ELISA at baseline and 6 weeks after the start of treatment. RESULTS Baseline levels of BDNF were not significantly different between the patient group and the controls. But male patients and the male controls showed statistical differences with respect to baseline BDNF levels. BDNF levels of the patient group did not change with treatment. Yet, the increase of BDNF levels was close to statistically significant in the fluoxetine group, whereas not significant in the venlafaxine group. There were no significant differences in baseline and 6th week BDNF levels between the responders and the non-responders. CONCLUSION Further studies controlling for a wide variety of confounding variables are needed, which may help to reach a clear conclusion about the potential of BDNF as a biomarker for depression or as a predictor of antidepressant efficacy.

Prevalence and risk factors of Internet addiction in high school students

AIM In this study, the prevalence and risk factors of Internet addiction in high school students was investigated. MATERIAL AND METHOD This cross-sectional study was performed in the Mersin Province in 2012. The study sample consisted of students attending high school in the central district of Mersin. The data were summarized by descriptive statistics and compared by a binary logistic regression. RESULTS Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception. CONCLUSION According to our study results, the prevalence of Internet addiction was high among high school students. We recommend preventing Internet addiction among adolescents by building a healthy living environment around them, controlling the computer and Internet use, promoting book reading and providing treatment to those with a psychological problem.

T102C and -1438 G/A polymorphisms of the 5-HT2A receptor gene in Turkish patients with obsessive-compulsive disorder.

OBJECTIVE This study aimed to investigate the possible association between T102C and -1438 G/A polymorphism in the 5-HT2A receptor gene and susceptibility to and clinical features of obsessive-compulsive disorder (OCD). METHOD Fifty-eight patients with OCD and 83 healthy controls were included in the study. All patients were interviewed and rated by Yale-Brown Obsessive-Compulsive Scale. T102C and -1438 G/A polymorphisms of 5-HT2A receptor gene were determined by PCR technique in DNAs of peripheral leucocytes. RESULTS OCD patients and healthy controls did not show significant differences in genotype distribution for both polymorphisms investigated. We found that frequencies of the TT genotype for T102C polymorphism and the AA genotype for -1438 G/A polymorphism were significantly higher in patients with severe OCD compared to those with moderate or moderate-severe OCD. CONCLUSION The -1438 G/A and T102C polymorphisms of the 5-HT2A receptor gene are not associated with an increased risk of OCD. Our data suggest that the TT genotype of T102C and the AA genotype of -1438 G/A polymorphism might be a factor in clinical severity of OCD.

Different neuroendocrine profiles of remitted and nonremitted schizophrenic patients

BACKGROUND Thyrotropin-releasing hormone (TRH) test and Dexamethasone Suppression Test (DST) are two neuroendocrine tests that have been extensively used in an attempt to predict treatment response and outcome in schizophrenia. The objectives of this study were to investigate (1) the relationship between TRH test and DST and various psychiatric symptoms and (2) the potential value of these tests in prediction of short-term outcome in schizophrenic patients. METHODS TRH test and DST were administered to 58 patients with schizophrenia. All patients were evaluated with a battery of rating scales before neuroendocrine test procedures and at regular intervals for 1 year. Patients were divided into two groups as remitted (RP; n = 30) and nonremitted patients (NRP; n = 28). Baseline results of these two groups were compared with each other and 30 healthy controls. RESULTS Basal levels of total T3 (T3T) and free T3 (T3F) were higher in RP group than controls. Basal prolactin (PRL) level was higher in RP group, but not in NRP, compared to controls. Basal growth hormone (GH) and thyroid-stimulating hormone (TSH) levels of NRP were significantly higher than those of RP. DST nonsuppression was observed at a significantly higher rate in RP than NRP and control group. Blunted TSH response rate in RP group was higher significantly compared to other two groups. CONCLUSIONS The data implicate that higher basal TSH and GH levels may be associated with a poorer treatment response, whereas higher total and free T3 levels, a blunted TSH response to TRH and nonsuppression on the DST may indicate a better response in schizophrenics.

Effects of venlafaxine and fluoxetine on lymphocyte subsets in patients with major depressive disorder: A flow cytometric analysis

BACKGROUND Studies have yielded conflicting results concerning flow cytometric lymphocyte analyses in patients with depression. Data about the effect of antidepressants on lymphocyte subsets are also contradictory. The aim of this study was to determine effects of venlafaxine versus fluoxetine on lymphocyte subsets in depressive patients. METHODS Sixty-nine patients diagnosed with major depressive disorder (MDD) according to DSM-IV and 36 healthy controls are included in the study. Sixty-nine patients were randomized to take fluoxetine (FLX) (n=33) or venlafaxine (VEN) (n=36). Serum lymphocyte subsets included CD3, CD4, CD8, CD16/56, CD19, CD45, Anti-HLA-DR which were measured by flow cytometric analyses at baseline and 6 weeks after the start of treatment. The severity of depression was evaluated with Hamilton rating scale for depression. RESULTS At baseline, patients with MDD had significantly lower CD16/56 ratio and higher CD45 ratio compared to the controls. Although numerically higher in the VEN treated patients, treatment response rates between the FLX (53%) and the VEN (75%) groups were not different statistically. CD45 values decreased significantly in the VEN group at the end of the 6 week treatment period whereas no difference was observed in the FLX group. By the 6th week, treatment responders showed a significantly higher CD16/56 ratio than non-responders. Baseline severity of depression and anxiety was positively correlated with baseline CD45 ratio and negatively correlated with baseline CD16/56 ratio. We did not observe consistent changes in the absolute number of circulating B or T cells, nor in the helper/inducer (CD4) or suppressor/cytotoxic (CD8) subsets. CONCLUSIONS CD16/56 was lower in patients with MDD and increased in treatment responders at 6th week. CD45 ratio was higher in patients with MDD than healthy subjects; it decreased with antidepressant treatment and was positively correlated with the severity of depression. Antidepressant treatment contributes to immune regulation in patients with major depressive disorder.

Assessment of pain and disability in patients with chronic low back pain: Reliability and construct validity of the Turkish version of the Quebec Back Pain Disability Scale and Pain Disability Index

Objectives: The objective of this study was to test the reliability and validity of the Turkish version of the Quebec Back Pain Disability Scale (QBPDS) and Pain Disability Index (PDI) as well as the retainment of the psychometric properties of the original versions. The importance of the region-specific functional measures on patients with chronic low back pain was also assessed. Methods: Eighty-three patients with chronic low back pain were enrolled in the study. The QBPDS, the PDI and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbachs alpha and item-total correlation. Validity was examined by correlating the QBPDS and PDI scores to external criteria scores at a single point in time, defined as cross-sectional construct validity. Results: Cronbachs alpha value for QBPDS and PDI was found 0.93 and 0.84 respectively, which were both statistically significant ( p< 0.0001). The item-total correlations of QBPDS varied between 0.28 and 0.76, and that of PDI varied between 0.30 and 0.73. The cross-sectional construct validity coefficients of QBPDS were 0.63 for PDI, 0.46 for Visual Analogue Scale (VAS), 0.28 and 0.16 for HADS. Correlation coefficients of PDI were 0.49, and those of VAS and HADS were 0.36 and 0.24 respectively. Conclusion: Our results are in accordance with the previous findings of the English and French versions of the QBPDS and English version of the PDI, indicating that these functional scales are valid and reliable. However, due to the considerable overlap between generic and region-specific functional instruments, the use of both scales is not necessary. We conclude that the QBPDS and PDI both measure predominantly functional status in patients with chronic low back pain.

Pulmonary muscle strength, pulmonary function tests, and dyspnea in women with major depression.

OBJECTIVE To evaluate the subjective sensation of dyspnea compared with pulmonary function tests, pulmonary muscle strength, and chest expansion in depressed women and control subjects free of cardiorespiratory disease. METHODS Thirty female patients with major depression (MD) and 30 age-matched female control subjects were included in the study. All subjects were assessed by pulmonary function tests (spirometry) and pulmonary muscle strength measurement (maximum inspiratory and expiratory pressures [MIP and MEP]) by mouth pressure meter (MPM). Chest expansion was measured, and body mass index (kg/m(2)) (BMI) was calculated. The Health Assessment Questionnaire (HAQ) was used to evaluate the activities of daily living, and a dyspnea score was used to determine dyspnea severity. RESULTS There were no significant differences between groups regarding pulmonary function tests, pulmonary muscle strength, and chest expansion. HAQ scores were significantly lower in women, and dyspnea was higher with MD compared with controls (p < 0.05). BMI was also lower in depressed patients (p < 0.05). CONCLUSIONS The subjective sensation of dyspnea is increased in women with MD in the presence of normal lung function and is associated with the level of anxiety rather than that of depression.

Majör depresif bozukluk ve yaygın anksiyete bozukluğunda malondialdehid ve E vitamini düzeyleri / Altered levels of malondialdehyde and vitamin E in major depressive disorder and generalized anxiety disorder

Altered levels of malondialdehyde and vitamin E in major depressive disorder and generalized anxiety disorder Introduction: Reactive oxygen species (ROS) may play a role in some neuropsychiatric disorders. There is some evidence that the activation of immune-inflammatory processes, an increase in monoamines catabolism and abnormalities in lipid compounds may cause overproduction of ROS and lipid peroxidation. These phenomena may be related to pathophysiology of major depressive disorder and generalized anxiety disorder. Malondialdehyde (MDA) is the end product of lipid peroxidation. Vitamin E is thought to play an important role as an antioxidant against lipid peroxidation. This study aims to investigate the role of oxygen radicals in the etiology of major depressive disorder and generalized anxiety disorder. Method: Plasma MDA and vitamin E levels of patients with major depressive disorder (n=42) and generalized anxiety disorder (n=37) were compared with healthy controls (n=38). To assess depressive symptoms and anxiety symptoms, Hamilton Depression Scale and Hamilton Anxiety Scale were applied. Results: Patients with major depressive disorder and generalized anxiety disorder had higher MDA and lower vitamin E levels than those of healthy controls. Differences between the patient and the control groups according to these two parameters were found statistically significant. Conclusion: Our results support the hypothesis that oxidative stress may affect depressive and anxiety

Symptomatic hypotension with venlafaxine–benzodiazepine interaction

Venlafaxine is an effective antidepressant drug that is chemically distinct from other antidepressants. Alprazolam is a triazolobenzodiazepine and diazepam is a 2-ketobenzodiazepine. Benzodiazepines are frequently co-administered with antidepressants, a fact that brings the problem of drug–drug interactions, because they are metabolized by various cytochrome pigment (CYP) 450 isoenzymes. We present three cases who developed symptomatic hypotension with co-administration of venlafaxine and benzodiazepines, namely, alprazolam and diazepam. In all cases, arterial blood pressure returned to normal with the discontinuation of pharmacological treatment. Although there is insufficient evidence, a substantial inhibition of CYP 3A3/4 by venlafaxine could result in a meaningful increase in plasma levels of venlafaxine, O-desmethylvenlafaxine, alprazolam and diazepam, particularly in patients who are CYP 2D6 deficient. A less likely explanation for the interaction between venlafaxine and benzodiazepines would be CYP 3A3/4 deficiency, which might potentiate the increase in plasma levels of benzodiazepines, thereby increasing their adverse effect potential. Combination of venlafaxine and benzodiazepines may increase the incidence and severity of adverse effects of both drugs.