Barbaros Özdemir

The association between serum levels of neopterin and number of depressive episodes of major depression

BACKGROUND There is an interaction between the immune system and the central nervous system by means of hormones, peptides, and neurotransmitters. The aims of the present study were to determine whether the serum neopterin levels in patients with major depression (MD) differ from a healthy control group and to investigate the relationship between previous MD episodes and serum neopterin levels. METHODS Thirty patients who were admitted to the GATA Psychiatry Outpatient Clinics and were diagnosed with MD according to DSM-IV, and who agreed to participate in the study, were included in the study. Twenty-six healthy volunteers matched for age, gender, and level of education who agreed to participate in the study were served as controls. Peripheral venous blood samples were obtained from the patients and the control group for complete blood count, routine biochemistry, and the detection of serum neopterin levels. The analyses were performed in the laboratory of the GATA Department of Biochemistry. RESULTS There was no significant difference between the MD group and the healthy controls with respect to age, level of education, smoking, and gender. Serum neopterin levels of the MD group who had experienced two or more episodes were higher than the first-episode group and the control group. Age of onset and the number of previous episodes had an independent impact on serum neopterin levels in MD patients, while smoking did not show any effect. CONCLUSION In the present study, the neopterin levels of patients who had experienced two or more episodes were higher than the first-episode depressive group and healthy control group. It was also found that the number of previous depressive episodes and the ages of the MD cases had an independent effect on serum neopterin levels.

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.

Aripiprazole as an Augmentation Agent in Treatment-Resistant Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a relatively common and severe disorder for which pharmacotherapy has been only minimally studied. BDD often appears to respond to selective serotonin reuptake inhibitors (SSRIs), but many patients do not respond or respond only partially. Investigation of SSRI augmentation strategies is therefore needed. We report a case of treatment-resistant BDD that was successfully treated with pharmacological augmentation of fluvoxamine with aripiprazole. The patient, a 43-year-old woman, had been taking a stable dose of fluvoxamine (400 mg/day) for 6 months when she was started on aripiprazole (10 mg/day). After 10 weeks of this treatment, her clinical condition improved markedly, as indicated by a significant decrease in the Body Dysmorphic Disorder Examination score. This case presents some preliminary evidence that addition of the atypical antipsychotic agent aripiprazole may be useful in patients with treatment-resistant BDD. However, results from controlled studies are needed to support this finding.

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.

Assessment of dissociation among combat-exposed soldiers with and without posttraumatic stress disorder

Background Dissociation is a disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including memory, identity, consciousness, perception, and motor control. A limited number of studies investigated combat-related dissociation. Objective The primary aim of this study was to evaluate the relationship between dissociative symptoms and combat-related trauma. Method This study included 184 individuals, including 84 patients who were exposed to combat and diagnosed with posttraumatic stress disorder (PTSD) (Group I), 50 subjects who were exposed to combat but were not diagnosed with PTSD (Group II), and 50 healthy subjects without combat exposure (Group III). The participants were evaluated using the Dissociative Experiences Scale (DES) to determine their total and sub-factor (i.e., amnesia, depersonalization/derealization, and absorption) dissociative symptom levels. In addition, Group I and Group II were compared with respect to the relationship between physical injury and DES scores. Results The mean DES scores (i.e., total and sub-factors) of Group I were higher than those of Group II (p<0.001), and Group IIs mean DES scores (i.e., total and sub-factors) were higher than those of Group III (p<0.001). Similarly, the number of subjects with high total DES scores (i.e.,>30) was highest in Group I, followed by Group II and Group III. When we compared combat-exposed subjects with high total DES scores, Group I had higher scores than Group II. In contrast, no relationship between the presence of bodily injury and total DES scores could be demonstrated. In addition, our results demonstrated that high depersonalization/derealization factor scores were correlated with bodily injury in PTSD patients. A similar relationship was found between high absorption factor scores and bodily injury for Group II. Conclusions Our results demonstrated that the level of dissociation was significantly higher in subjects with combat-related PTSD than in subjects without combat-related PTSD. In addition, combat-exposed subjects without PTSD also had higher dissociation levels than healthy subjects without combat experience.

Treatment of major depression with sertraline: Relationship between serum neopterin levels and respond to the treatment -

OZETAmac: Bu calismanin amaci major depresyon (MD) olgularinda serum neopterin duzeylerinin tespiti suretiyle bagisiklik sisteminin aktivasyonunu incelemek ve tedavi oncesi serum neopterin duzeyler...

Aggression and the event-related potentials in antisocial personality disorder

Objective: In this study, we measured event related potentials (ERPs) in a male sample of antisocial personality disorder (ASPD) patients who were free of substance and alcohol abuse and compared them with those of normal subjects. We also aimed to determine whether or not there was a correlation between aggressive behaviors and ERPs . Materials and Method: A total of 42 ASPD patients and a control group of 44 healthy subjects were enrolled in the study. In both groups, the subjects had not used alcohol or any psychotropic medicine for at least 15 days prior to enrollment. Results: There were no significant differences in age, education, and marital status between the ASPD and control group. P3 amplitude (AP3) values were significantly lower in the ASPD group compared to the controls (p

Evaluation of peer effects on eating behaviors: a cluster analysis approach

ABSTRACT Objectives: In this study, we aimed to determine the effects of socio-demographic characteristics and the peer groups on the eating attitude and body mass index (BMI) of students at a medical school in Turkey. Methods: This cross-sectional study was conducted with the participation of the students of Gulhane Military Medical Academy (GMMA). Ethical permissions of the study were obtained from the GMMA Ethics Committee. The target population of the study consisted of 703 students, 533 of whom (75.8%) agreed to participate in the study. The Eating Attitudes Test (EAT) was administered to the participants and their BMI was noted. The EAT consists of 10 questions that measure the socio-demographic characteristics of the participants and 40 questions that evaluate eating habits. In order to determine the peer groups of the students, each student was asked to provide the numbers of their three closest friends. Three peer groups were generated for each grade by applying cluster analysis and as a result 18 peer clusters were examined. Results: In this study, the average EAT score was 12.5 ± 6.9, and the mean BMI was 23.1 ± 2.4. It was found that the EAT score of 2.4% of the students was equal to or exceeding 30; 0.4% were obese; 21.0% were overweight; and 2.1% were slim. There was a significant difference between the grade level of the students and sport habits (p values respectively; p < .001, p = .015) in terms of the comparison of the EAT score to socio-demographic characteristics. In the analysis of variance between 18 clusters generated according to the cluster analysis, a statistically significant difference was found in terms of both BMI and the EAT (p values <.001, <.001, respectively). This suggests that students with similar eating habits and similar BMI levels have a tendency to cluster among similar peer groups. The variables that effect the EAT scores and BMI levels of the students were evaluated by the analysis of covariance. It was found that students’ smoking status (p = .039) had a statistically significant effect on BMI after it was adjusted according to peer group and grade. Also, it was found that the grade (p = .011) and peer cluster (p = .021) had a statistically significant effect on eating habits. Conclusions: The peer groups may affect both eating attitudes and BMIs. In medical literature several studies exist that support these findings. But it is a novel approach to identify peer groups by using clustering algorithms and our study has been able to demonstrate the relationship of peer group and eating habits with this method.

The Effect of Stress and Depression on Gastrointestinal Diseases

TO THE EDITOR: In a recent issue of the Journal of Neurogastroenterology and Motility, we were very interested in the article by Lee et al1 entitled “The Effect of emotional stress and depression on the prevalence of digestive diseases” in which the investigators reported that stress and depression are related to various digestive diseases and may be predisposing factors for functional dyspepsia and irritable bowel syndrome, and that depression may be a predisposing factor for gastric cancer. This study is well designed but we would like to comment on some of the factors that can affect depression and stress as these may shed new light on the author’s interpretations. Large-scale studies that aim to determine psychological processes such as depression and stress levels in psychosomatic diseases such as gastrointestinal diseases should meticulously consider the risk factors that affect these processes. At the same time, the inclusion and exclusion criteria should be well structured. For example, the main factors that affect stress and depression levels are psychotropic medication and regular exercise. We know that both psychotropic medication2 and regular exercise3 decrease levels of depression and stress. The study by Lee et al1 did not specify whether or not participitants used psychotropic medication or exercised regularly, nor did it specify if these factors were used as exclusion or inclusion criteria. In addition, most women begin to experience emotional changes before and during menstruation period which are known as premenstrual syndrome (PMS).4 Symptoms of PMS include affective, physical, cognitive, and behavioral changes. Affective symptoms include irritability (ie, a cardinal symptom), mood swings, anxiety, and depression.5–6 These psychological symptoms do not only occur during PMS but can also be seen during and after menopause. Upon entering menopause, women may experience a wide range of feelings, from anxiety and discomfort to release and relief.7–8 Thus, stress and depression levels show fluctuations during the menstrual cycle and menopausal period. In this study, the authors did not state the menstrual status of female individuals which could cause unnaturally lower or higher stress and depression levels. We think that it is highly important to examine these issues in order to reliably interpret the study results. Clarifying these 2 concerns will provide a clearer picture when interpreting stress and depression levels among participants.

Posttraumatic Stress Disorder Patients and Results of Violent Behavior

AIM: High levels of anger and aggression in post-traumatic stress disorder lead to unfavorable social, legal, physical and economic results to family members and the other social layers as much as patients. In this study, it is aimed to investigate the relation between both alcohol-cigarette consumption ratios and anger levels, characteristics of aggressive behaviors and the judicial outcome in cases diagnosed post-traumatic stress disorder due to armed conflict. METHODS: 38 cases diagnosed as post-traumatic stress disorder were included to the study. Pre- and post-traumatic alcohol/cigarette consumption amounts and aggressive behaviors are determined. Impact of Events Scale (Revised) (IES-R) was used for evaluating post-traumatic stress disorder symptom patterns and severity, Buss Perry Aggression Questionnaire was used for measuring anger and aggression levels, and Taylor’s Violence Rating Scale was used for evaluating the judicial outcome of aggression. RESULTS: 23 of cases (60.6%) were married with children, 13 of cases (34.25) were single and 2 of cases (5.2%) were divorced.18 of cases (47.4%) were graduate. IES-R total score was 66,9 ± 12,7, Buss Perry total score was 111,3 ± 20,5, and Taylor’s Violence Rate was 2,5 ± 1,0. When the pre- and post-traumatic aggressive behaviors were compared; physical violence to the partner was increased more than ten times, Physical and verbal violence to social individuals were increased more than four and seven times, respectively. And also it is observed that inflicting damage to property was increased 17 times, reckless driving was increased 11 times, and self-mutilation was increased 5 times. Alcohol consumption was determined as 0 (0 - 126) g/day for pre-trauma cases and 16.5 (0 - 294) g/day for post-trauma cases. Cigarette smoking was determined as 5 (0 – 40) cigarette/day for pre-trauma cases and 30 (0 -60) cigarette/day for post-trauma cases. CONCLUSION: Post-traumatic stress disorder associated with high levels of anger and aggression and alcohol can cause familial-marital problems, breaking up a family, increase in judicial problems and arrest, increase in ratios of self-mutilation and severe bodily injuries, physical violence to patterns and children, progressing of post-traumatic stress disorder, severe mental situations such as depression and suicide. For these reasons, careful detecting of alcohol-drug abuse and overstimulation symptoms as anger/aggression in post-traumatic stress disorder, and rapid target-driven psychopharmacologic and psychotherapeutic interventions Become more of an issue.