Bahadir Demir

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.

Psikiyatrik hastalığı nedeniyle yatarak tedavi gören gebe hastaların klinik ve sosyodemografik özellikleri ve izlem sonuçları

Sociodemographic characteristics and clinical follow-up results of pregnant patients hospitalized for psychiatric disorders Objective: Important psychosocial changes occur in pregnancy. During pregnancy exacerbation of existing psychiatric symptoms may be seen or psychiatric symptomsmay be experienced for the first time. In this study, clinical and sociodemographic data of pregnant patients, who were hospitalized in our clinic, their follow-up results and potential effects of psychiatric disorders on newborns and course of pregnancy were investigated. Method: Clinical and sociodemographic data of 68 pregnant women, who were treated as in-patient for psychiatric disorders were analyzed retrospectively. Results: Most of the psychiatric disorders were found to occur at 2nd trimester. While 23.5% of the patients (n=16) had a diagnosis of psychiatric disorder for the first time during their pregnancy, 76.5% of them (n=52) had already a psychiatric disorder prior to pregnancy. Preterm birth was not observed in any of the 47 patients, who had available information. Based on birth information gathered from 52 infants; there were no disease detected in 50 of them whereas congenital hip dislocation in one of them and temporary heart problem were detected in another. Conclusion: Preterm birth was not associated with psychiatric treatment during pregnancy. Most of the psychiatric disorders were seen at 2nd trimester. Therefore follow-ups of pregnant patients should be held more carefully at 2nd trimester. And those who had a previous psychiatric treatment history should be monitored in terms of psychiatric disorders carefully during pregnancy.

Phenprobamate dependence: A case report

Phenprobamate (3-phenylpropylcarbamate) is a centrally acting muscle relaxant with mild sedative and anticonvulsant effects. Muscle relaxants can enhance and prolong the effect of narcotic drugs and enable to obtain same effect with a smaller amount of alcohol or illicit substance. Almost all of the centrally acting muscle relaxants have varying sedative effects on which their abuse potential mainly depends. Data related to abuse of carisoprodol, meprobamate, baclofen takes place in the literature. However, to our knowledge this is the first case report about abuse of and tolerance to phenprobamate. We aimed to attract attention to important points of prescribing drugs that have abuse potential like in our case who was using up to 16000 mg/day phenprobamate.

Both typical and atypical long-acting injectable antipsychotics in bipolar disorder: a retrospective chart review -

Amaç: İkiuçlu bozukluk (İUB) tanı ve tedavi sürecinde zorluklar içeren ve kronik seyir gösteren psikiyatrik bir bozukluktur. İUB idame tedavisinde en büyük sorunlardan biri ilaç uyumunun sağlanmasıdır. Uzun etkili enjektabl (UEE) antipsikotikler bu tür hastalarda ciddi avantajlar sağlamaktadır. Biz bu çalışmada, tipik ve atipik UEE antipsikotikleri tedavi öncesi ve sonrasındaki bir yıllık dönemde klinik özellikler, hastane yatış sayıları ve yan etkiler açısından ayrı ayrı karşılaştırmayı amaçladık. Yöntem: Çalışma evreni Gaziantep Üniversitesi Duygudurum Birimi’nde takip edilen 802 İUB hastasından oluşturuldu. Bu hastalardan 80’i tipik ya da atipik UEE antipsikotik kullanıyordu. Çalışma kriterlerini karşılayan sadece 31 hasta çalışmaya dahil edildi. Etkinlik; tedavi öncesi ve sonrası bir yıllık dönem içindeki KGI, YMDÖ, HAMD skorları (12 ay önce, 6 ay önce, tedavi ekleme zamanı, 6 ay sonra ve 12 ay sonra), hastaneye yatış oranları ve ortalama yıllık hecme sayıları karşılaştırılarak değerlendirildi. Bulgular: Çalışma örnekleminde UEE antipsikotik kullanım oranı %9.88 olarak tespit edildi. İdame tedavide UEE antipsikotiklerin yıllık ortalama atak sayısını azalttığı ve depresyondan ziyade manik atağı önlemede etkin olduğu gösterildi. Atipik antipsikotiklerin YMDÖ ve KGI skorlarını anlamlı oranda azalttığı tespit edilirken HAMD skorlarında anlamlı bir değişiklik gözlenmedi. Tipik antipsikotikler ile ise ölçek skorlarının hiçbirinde anlamlı bir değişiklik görülmedi. Tipik ve atipik UEE antipsikotikler yan etkiler açısından tedavi öncesi ve sonrasında karşılaştırıldığında anlamlı bir farklılık saptanmadı. Tartışma: Çalışmamız bizim bilgilerimize göre, İUB’de atipik ve tipik UEE antipsikotiklerin birlikte dahil edildiği ilk çalışmadır. Sonuç olarak; UEE antipsikotiklerin manik atak korumasında etkin olabileceği ve yan etkiler açısından da tedavi öncesi ve sonrasında bir değişikliğin olmadığı gösterilmiştir. Hasta sayısı artırılarak yapılacak yeni çalışmalarla çalışmamızın sonuçlarının tekrar edilmesine ihtiyaç vardır.

Electroconvulsive therapy in a major depression patient with arachnoid cyst

Electroconvulsive therapy in a major depression patient with arachnoid cyst Arachnoid cyst develops when two layers of arachnoid membrane fail to unite in early fetal life causing cerebrospinal fluid accumulation and formation of a cyst. Arachnoid cysts constitute 1% of space occupying lesions in the brain. Diagnosis is made usually with regular medical examinations. They can cause epilepsy, increased intracranial pressure, neurological deficits, macrocranium and growth deficit in children, and subdural hematoma. It has been recommended to be careful when administrating Electroconvulsive therapy (ECT) to the patients with space occupying lesions. ECT can cause adverse effects in patients with arachnoid cyst by increasing intracranial pressure. Arachnoid cyst can rupture and give symptoms by causing subdural effusion, subdural hemorrhage or intracystic hemorrhage. In this case, we diagnosed major depression and arachnoid cyst. We administered ECT to the patient who had suicide ideation and was resistant to pharmacotherapy. Patient’s complaints fully recovered with ECT. The size of arachnoid cyst didn’t increase and we observed no complication. In this case, we aimed to show that ECT could be successfully administered to the patients with arachnoid cyst.