Aysun Kalenderoglu

Decreases in ganglion cell layer and inner plexiform layer volumes correlate better with disease severity in schizophrenia patients than retinal nerve fiber layer thickness: Findings from spectral optic coherence tomography

BACKGROUND Optic coherence tomography (OCT) is a new, contactless and fast neuroimaging method. Previous studies have observed thinning of the retinal nerve fibre layer (RNFL) in many neurodegenerative diseases, and researchers have suggested that correlations exist between the thinning of the RNFL and the neurodegeneration detected with other imaging methods or the severity of illness. More recently, OCT has been used in patients with schizophrenia. RNFL thinning has also been detected in these patients. With more sophisticated devices, segmentation of the retina and measurements of the ganglion cell layer (GCL) and internal plexiform layer (IPL) can be performed. METHODS We measured the RNFL thickness and the GCL and IPL volumes in 40 treatment refractory patients with schizophrenia, 41 treatment responsive refractory patients and 41 controls using spectral-OCT, and we evaluated the correlations between the disease severity and OCT measurements. RESULTS The global RNFL thickness and GCL and IPL volumes were decreased in the patients with schizophrenia compared with the controls. In addition, the GCL and IPL volumes were lower in the treatment refractory patients with schizophrenia compared to the treatment responsive patients. Using parameters such as the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scores, the disease duration and number of hospitalizations, correlations between the GCL and IPL volumes and disease severity were stronger than the correlations between the RNFL and the disease parameters. CONCLUSION Our findings suggest that OCT can be used to detect neurodegeneration in schizophrenia and that the GCL and IPL volumes can also be used to monitor the progression of neurodegeneration.

Can the retinal ganglion cell layer (GCL) volume be a new marker to detect neurodegeneration in bipolar disorder

PURPOSE The aim of this study was to compare the ganglion cell layer (GCL) volume and retinal nerve fiber layer (RNFL) thickness in bipolar patients and controls using optic coherence tomography to demonstrate neurodegeneration in bipolar disorder. METHODS This study involved 43 euthymic bipolar I patients who were being followed by the Psychiatry Department of Adiyaman University Medical School and 43 healthy volunteers as controls. Optic coherence tomography (OCT) measurements were performed for both groups. The RNFL thickness and GCL volumes were measured and recorded automatically by a spectral OCT device. FINDINGS No differences in sociodemographics were detected between groups, except for unemployment status, which was significantly higher in the patient group. The RNFL thickness was lower in patients compared with controls at all measured regions, and this decrease was statistically significant for the global RNFL measurement. The GCL volume was also significantly lower in the patient group. There was a significant negative correlation between the disease parameters, such as the disease duration, YMRS score, CGI score, and number of hospitalizations, and GCL volume. DISCUSSION These findings suggest that neurodegeneration occurs during the course of bipolar disorder. This degeneration may be demonstrated by decreased GCL at early stages, and as the disease progresses, involvement of other retinal layers, such as the RNFL and IPL, may be observed.

Spontaneous Ejaculations Associated with Aripiprazole

Sexual side effects are common with antipsychotic use. Spontaneous ejaculations without sexual arousal have been previously described with several typical and atypical antipsychotics. We report the case of a man who had spontaneous ejaculations after stopping risperidone and starting 30 mg/day aripiprazole. Spontaneous ejaculations ceased 3 days after decreasing the aripiprazole dose to 15 mg/day. He denied sexual fantasies or increased sexual desire during the period in which he had spontaneous ejaculations. The partial agonistic effect of aripiprazole on D2 receptors may have augmented the mesolimbic dopaminergic pathway, which was suppressed by risperidone, causing spontaneous ejaculations in this patient. Serotoninergic effects of aripiprazole should also be considered. This unusual side effect should be questioned, particularly in patients who recieve aripiprazole after D2-blocking antipsychotics; otherwise, this side effect may cause embarrassement and noncompliance.

Optic coherence tomography shows inflammation and degeneration in major depressive disorder patients correlated with disease severity

BACKGROUND Previous research has consistently detected inflammation in the etiology of depression and neuroimaging studies have demonstrated gray matter abnormalities implying a neurodegenerative process in depression. The aim of this study was to compare ganglion cell layer (GCL), and inner plexiform layer (IPL) volumes and retinal nerve fiber layer (RNFL) thickness between first episode and recurrent major depressive disorder (MDD) patients and controls using optic coherence tomography (OCT) in order to detect findings supporting a degenerative process. Also choroid thicknesses of the same groups were compared to examine effects of inflammation on MDD. METHODS This study included 50 recurrent MDD patients, 50 first episode MDD patients and 50 controls. OCT measurements were performed by a spectral OCT device. GCL and IPL volumes and RNFL and choroid thicknesses were measured automatically by the device. RESULTS GCL and IPL volumes were significantly smaller in recurrent depression patients than first episode patients and in all MDD patients than controls. Also there were significant negative correlations between their volumes and disease severity parameters such as Ham-D and CGI scores, and disease duration. RNFL thicknesses were also lower in recurrent MDD patients than first episode patients and all MDD patients than controls but statistical significance was achieved only for global RNFL and temporal superior RNFL. Mean choroid thickness was higher in MDD patients than controls and in first episode MDD patients than recurrent MDD patients. LIMITATIONS Cross-sectional design of our study limits conclusions about progressive degeneration during the course of MDD. Lack of a control neuroimaging method like magnetic resonance imaging makes it hard to draw firm conclusions from our results. CONCLUSIONS OCT finding of decreased GCL and IPL volumes supports previous research suggesting degeneration in MDD. OCT may be an important tool to track neurodegeneration in patients with major depression. Considering RNFL to be the latest layer that will be affected during course of degeneration, GCL and IPL volumes appear to be better parameters to follow. In addition, choroid may be an important structure to detect acute attack period and to follow inflammatory process in MDD like in systemic inflammatory diseases.

Complete blood count alterations due to the opioid use: what about the lymphocyte-related ratios, especially in monocyte to lymphocyte ratio and platelet to lymphocyte ratio?

ABSTRACT This study was designed to compare the complete blood count values of opioid users (N = 61) and healthy subjects (N = 61), particularly monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR). PLR, MLR, and percentage of monocyte (MONO%) were significantly lower in opioid use disorder (OUD) group (P = 0.012, P = 0.005, P = 0.000). The area under the ROC curve of MLR and PLR levels for OUD was 0.349 and 0.368. MONO% correlated with substance use duration. Measurements like lymphocyte-related ratios and MONO% in opioid use can be important in substance monitoring, detection, and differentiation of acute and chronic conditions.

Improvement of an atypical Kikuchi-Fujimoto disease (KFD) with antidepressant treatment: the first psychiatric approach to a KFD case

ABSTRACT Kikuchi-Fujimoto disease (KFD) is a sporadic and benign disorder of the lymph nodes of young individuals. A preceding fever, occasional skin rashes, and lymphopenia, suggest a viral aetiology and there have been reports of viral association. However, so far, no infectious agent has been proved to be aetiologically related. We herein report KFD in a 27-year-old female who presented with fevers, weight loss and tender cervical lymph nodes. The patient had depressive symptoms before the onset of KFD. During the disease process, depressive symptoms worsened with the KFD course. She had not relieved with the supportive treatment and major depressive disorder (MDD) became more severe gradually. After the treatment of MDD and with the improvement of mental health, clinical symptoms and the lymph node growth became reversed. The authors conclude that this clinical course of KFD with the treatment of MDD suggests an immune system response or immunological problem in these patients.

Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”

ABSTRACT Cotard is a syndrome that is characterized by ideas of damnation or rejection, anxious melancholia, insensitivity to pain, and nihilistic delusions concerning one’s own body or existence. It is most often encountered in middle age or older women who are severely depressed. Capgras syndrome is a rare psychiatric disorder with colourful symptoms. The patient believes that the identities of close relatives or friends are not real but are replaced by others. Co-existences of psychiatric and organic diseases with Cotard’s syndrome and Capgras syndrome are reported in different studies. There is still requirement of more research to establish a position in diagnostic classification systems for these syndromes which are thought to have a multifactorial etiology. In this report, we described a patient with bipolar disorder type-2 who displayed comorbid Cotard and Capgras delusions which were most evident at the onset of menstrual periods.

Psychiatric Disorders And Eye: Optical Coherent Tomography In Psychiatry Aspect

Optic coherence tomography is a novel imaging method which can demonstrate biological tissue layers by getting high resolution sections. This technique measures delay time and intensity of ~800 nm wavelenght infrared light which is transmitted to and reflected from different tissue layers. It gives cross sectional images of tissues similar to but with much higher resolution (1-15 μm) than ultrasonography. OCT method was first described by Fujimoto et al from Massachusettes Institue of Technology. Then its use in ophthalmology and in neurology were described. Especially with today’s OCT technology resolution is enhanced and differentiating ganglion cell komplex (GCC) (RNFL, GCL, IPL) from other parts of retina is now possible. Another parameter that can be measured with OCT is choroidal thickness. Choroid is among the most vascularized tissues in human body and it has important roles in oxygenization and nutrition of outer retina, temperature regulation of the retina, arrangement of the position of retina, disposition of waste products from retina, and release of growth factors. Thus, any vascular pathology can cause choroidal thinning.

Copycat Suicides Without an Intention to Die After Watching TV Programs: Two Cases at Five Years of Age

Suicide is an intentional self-destructive act. As conceptualization of death as an irreversible end occurs at approximately 8-10 years, attempted and completed suicides are rare before 7 years of age. Studies have suggested that media may contribute to increased suicides in adolescents through social learning. Effects of media on suicides were thoroughly evaluated in children and adolescents who committed suicide after identifying with the subject of a TV program, movie, or book. We present 2 cases at 5 years of age who committed suicide by hanging themselves after watching a TV program. These cases differed from copycat suicides reported in the literature that are performed mostly by adolescents because victims are very young children and because they died without an actual intent to die while they were imitating suicides. By presenting these cases, we want to emphasize that destructive effects of media may involve not only adults and adolescents but also very young children who do not have a completely developed concept of death.