Burç Çağrı Poyraz

The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional outcome in bipolar disorder.

BACKGROUND Cognitive impairments and subsyndromal depressive symptoms are present during euthymic periods of bipolar disorder (BD). Most studies have determined that cognitive impairments and residual depressive symptoms have major impacts on psychosocial functioning. The aim of the present study was to identify the major factor responsible for low psychosocial functioning in a subgroup of patients with BD despite clinical recovery. METHODS Sixty patients with bipolar I disorder and 41 healthy subjects were enrolled in this study. Cognitive performance, neurological soft signs (NSSs), psychosocial functioning, residual mood symptoms and illness characteristics were assessed. Using the median value of the Functioning Assessment Short Test (FAST) as the cut-off point, the patients were divided into two groups, high- (n=29) or low-functioning (n=31), and they were compared based on total NSS, residual depressive symptoms, cognitive performance and clinical variables. RESULTS Performances on the verbal memory tests and social functioning were significantly worse in the euthymic patients with BD. Increased rates of NSS were identified in the patients compared with the normal controls. The low-functioning patients performed significantly worse on verbal memory, and their NSS and residual depressive symptoms were significantly higher compared to high-functioning patients. In the regression analysis, subsyndromal depressive symptoms and verbal learning measures were identified as the best predictors of psychosocial functioning. LIMITATIONS The patients were artificially separated into two groups based on a FAST score cut-off. CONCLUSIONS In this study, residual depressive symptoms and verbal memory impairments were the most prominent factors associated with the level of functioning.

Increased incidence of autoimmune thyroiditis in patients with antipsychotic-induced hyperprolactinemia

Prolactin (PRL) elevation in patients with prolactin-secreting pituitary tumors has been linked to increased prevalence of thyroid autoantibodies. However, the effects of antipsychotic drug-induced hyperprolactinemia (HPRL) on development of thyroid autoimmunity and also of other autoimmune phenomena have not been previously studied. To examine whether serum PRL levels were associated with the prevalence of thyroid autoantibodies in patients with schizophrenia receiving long-term antipsychotic treatment, we determined serum PRL, thyrotropin, free thyroxine levels, and the presence of antithyroid peroxidase and antithyroglobulin antibodies in 75 consecutive, clinically stable schizophrenic outpatients who had been on stable doses of antipsychotics for at least 3 months, and had no history of overt thyroid disease. We found that the prevalence of hyperprolactinemia was significantly higher in patients positive for thyroid autoantibodies, when compared with patients negative for them (p=0.045). Serum levels of prolactin were also significantly higher in patients with positivity for thyroid autoantibodies (p=0.039). In separate analyses for genders, a trend-level relationship was observed in females between increased levels of prolactin and the presence of thyroid autoantibodies (p=0.060). Our findings suggest that through the associated HPRL, long-term antipsychotic treatment can induce thyroid autoimmunity. Future research is required to investigate, whether other autoimmune processes might be triggered by antipsychotic drug-induced HPRL, and to what extent the immune alterations reported in patients with schizophrenia are related with this phenomenon.

Minor physical anomalies and neurological soft signs in patients with schizophrenia and their siblings

Neurological soft signs (NSSs) and minor physical anomalies (MPAs) are consistently found at higher rates in individuals with schizophrenia compared to healthy controls. However, limited research has been conducted on these traits among the biological relatives of these patients. We aimed to identify the possible origins of these traits in schizophrenia by exploring them in patients with schizophrenia, their healthy siblings and normal controls. Ninety-six patients with schizophrenia, their 66 non-psychotic siblings and 52 healthy subjects were studied. Measures included the Neurological Evaluation Scale, a structured examination for detection of minor physical anomalies, stroop and verbal fluency tests for cognitive assessment, and scales for assessment of disease severity in patients; the Scale for the Assesment of Negative Symptoms and the Scale for the Assesment of Positive Symptoms. Increased rates of NSSs and high MPA scores were found in both the patients and their siblings as compared to normal controls. MPAs in several body regions were similar (eyes, ears, hands and feet) or correlated (innercanthal width and head circumference) between patients and their respective siblings. However, there was little similarity in palate and tongue anomalies between these subjects. These results suggest that NSSs and MPAs might represent two distinct markers of risk for schizophrenia. MPAs at different locations may also represent distinct pathological processes, such that palate and tongue abnormalities are more likely to represent non-familial rather than familial factors compared to other abnormalities.

Use of social network sites among depressed adolescents

ABSTRACT Social network sites (SNSs) are relatively new phenomena, and the relationship between SNSs and psychopathology remains unclear. The purpose of this study was to evaluate the type of SNSs depressed adolescents use and the incidence of depressive disclosure on SNSs among them. The study was designed to be cross-sectional. The sample consisted of 53 adolescents diagnosed with depressive disorder, as confirmed by K-SADS-PL, and 55 non-depressed adolescents. The Children’s Depression Inventory, Social Anxiety Scale and Social Network Use Questionnaire were administered. The primary finding was that the amount of time spent on the Internet and on SNSs was significantly higher among depressed adolescents than non-depressed adolescents. Additionally, depressed adolescents reported significantly higher disclosure of anhedonia, worthlessness, guilt, loss of concentration, irritability and thoughts of suicide on SNSs. The intensity of the depression sharing was significantly higher in the depressed group. Depressed young people use social networks to express their symptoms. Adolescents’ disclosure on social networks may be able to guide relatives, friends and mental health professionals.

Lower limb flexor reflex: Comparisons between drug-induced akathisia and restless legs syndrome

BACKGROUND AND OBJECTIVE Akathisia is characterized by restlessness and crawling sensations similar to restless legs syndrome (RLS). Long latency flexor reflex (LLFR) which has helped to advance RLS pathophysiology has never been investigated in akathisia. Due to the clinical commonalities of akathisia and RLS, we investigated the behavior of LLFR in patients with akathisia aiming to understand pathophysiology of akathisia. PATIENTS AND METHODS Seven patients with neuroleptic-induced akathisia, 12 drug-naïve patients with primary RLS and 17 healthy subjects were prospectively enrolled in the study. LLFR was recorded from unilateral tibialis anterior (TA) and long head of biceps femoris (BF) muscles after stimulating the sole by trains of electrical stimuli. We measured amplitude, latency, duration, presence of response and compared between three groups. RESULTS One-way ANOVA showed mean durations of early and late responses recorded over TA were the longest in akathisia group compared to both RLS group and healthy subjects (p=0.012). The spatial spread of LLFR in akathisia patients was comparable to those of healthy subjects whereas presence of response on BF was significantly less in akathisia than RLS group. CONCLUSIONS Our findings indicate increased excitability of LLFR pathway in akathisia group. These findings are probably due to lack of inhibition originated in regions other than those known to downregulate in RLS.

T102C Polymorphism of Serotonin-2A Receptor Gene in Turkish Schizophrenia Patients: Association with Cognitive Impairment and Soft Neurological Signs

Aim: Previous studies have shown an association between the T102C polymorphism of the serotonin-2A receptor gene and schizophrenia. In addition, an association of this polymorphism with clinical phenotypes in schizophrenia such as treatment response and cognitive impairment has been observed. Materials and Methods: In this case-control study conducted in Turkish Caucasians, we compared T102C polymorphism genotype and allele frequencies in 76 schizophrenic patients and 165 healthy controls. We also investigated interaction of this polymorphism with clinical and cognitive variables in patients. Results: No significant difference was observed in the distribution of the three genotypes (T/T, T/C and C/C) and in the allele frequencies in controls and patients with schizophrenia. No evidence of association was detected at various clinical phenotypes including symptom severity, suicidality, treatment response, age of disease onset, number of hospitalizations and history of violence (in co-dominant, dominant, or recessive models). However, as compared to the C/C genotype, patients with 1 or 2 copies of the T allele were characterized by better stroop test performances and less “motor coordination” soft neurological signs. Conclusion: Further research is needed to elucidate the impact of T102C polymorphism on neurocognitive functions in both healthy and patient populations.

Brainstem reflexes are hyperactive in patients with drug-induced akathisia

Akathisia is a sensori-motor phenomenon which is generally encountered as an adverse effect of antidopaminergic medications suggesting involvement of dopaminergic pathways. We recently showed nociceptive flexor reflex was altered in akathisia as compared to restless legs syndrome and therefore, these findings may indicate co-involvement of pathways other than dopaminergic ones. To examine functional status of different pathways, we investigated auditory startle reflex (ASR), startle response to somatosensory input (SSS), and trigemino-cervical reflex (TCR) in a group of patients with akathisia. Consecutive seven patients with drug-induced akathisia and age- and gender-matched healthy subjects were prospectively included in the study. The diagnosis was made by appropriate clinical criteria. Brainstem reflexes, ASR, SSS, and TCR were examined in all participants. The probability, onset latency, amplitude, and duration were measured and compared between groups. The probability and amplitudes of ASRs were significantly increased and durations of ASRs and TCRs were prolonged in the patient group. Latencies of all responses as well as patterns of startle responses were similar between groups. The results reveal hyperactivity of the ASR and TCR in drug-induced akathisia. Hyperactive ASRs and TCRs also confirm suprasegmental hypodopaminergic state in akathisia. Although we keep in mind the confounding effects due to concurrent antidopaminergic treatments and the small sample group, we speculate that hyperactive ASRs and TCRs might be related to deficient control by forebrain and limbic—mainly amygdala—network in patients with drug-induced akathisia.

Successful use of electroconvulsive therapy in a patient with anorexia nervosa and severe acute-onset obsessive-compulsive disorder

Anorexia nervosa (AN) is a complex condition that is often accompanied by several serious comorbidities that may require a variety of treatment modalities throughout the course of the illness. Obsessive-compulsive disorder (OCD), which is common in patients with AN, may occasionally cause serious interruptions to the daily functioning of the patient. We report on a 24-year-old male patient with chronic AN. During the beginning of his illness, he had a major depressive episode that was followed by AN onset. Throughout his illness, he also experienced chronic moderate depressive symptoms and later developed severe OCD. He experienced complete remission from the OCD and an improved mood after undergoing a course of bilateral electroconvulsive therapy (ECT). His OCD symptoms did not recur during the first year of follow-up. ECT may prove to be a fast and effective treatment strategy for severe and disabling acute-onset OCD that occurs during the course of comorbid AN. The case described herein shows how a comorbid psychiatric disorder in a patient suffering from chronic AN may disrupt the daily functioning of the patient if it is not urgently treated.

Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up

ObjectiveTo assess prospectively the prevalence of impulse control disorders (ICD), psychiatric symptoms, and their clinical correlates in patients with prolactinoma receiving dopamine agonists (DA) in comparison to those with non-functioning pituitary adenomas (NFA) and healthy controls (HC).MethodsA total of 25 patients with prolactinoma, 31 with NFA, and 32 HCs were included in the study. All patients and controls were screened for the presence of ICDs and other psychiatric disorders using revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Barratt Impulsiveness Scale (BIS-11), Symptom Check List (SCL-90-R) questionnaire and Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).ResultsWe detected two new cases (8%) of ICD associated with DAs. Both cases presented with hypersexuality, which reversed totally or decreased upon discontinuation of the drug. The re-challenge of the DA in a smaller dose has led to either no symptoms or weaker symptoms than before. There was an increase in the number of patients who screened positive on obsession, interpersonal sensitivity, paranoid ideation, and additional items subscales of SCL-90-R in comparison to HCs at the end of the study period (p < 0.05 for all). Likewise, cumulative DA dose was positively correlated to obsession, interpersonal sensitivity, paranoid ideation, hostility, phobic anxiety subscales, and GSI scores of SCL-90-R (p < 0.05 for all).ConclusionsDAs are associated with a small but substantial short-term risk of ICD development and a broad range of psychiatric symptoms in patients with prolactinoma receiving DAs.

Reliability and Validity of Rowland Universal Dementia Assessment Scale in Turkish Population

Background: The aim is to validate Turkish version Rowland Universal Dementia Assessment Scale (RUDAS). Methods: One hundred forty patients (>65 years) were included. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition -V was used in all patients. Rowland Universal Dementia Assessment Scale was applied for 2 days. Results were compared with Mini-Mental State Examination; reliability, validity, and statistical values were determined. Results: Time validity was verified. Mini-mental state examination was correlated 45.3% in control and 73% in dementia group. Factor weights varied between 0.44 and 0.81; factor construct was verified as 6-item scoring. When 25 was cutoff point, sensitivity was 92.86% and specificity was 92.86%. Content validity index was found to be 100% by 7 specialists. Cronbach α (0.692) and test–retest reliability (intraclass correlation = 0.987) were determined. Conclusion: Rowland Universal Dementia Assessment Scale (Turkish) is validated and verified as reliable. Test could be applied for 5 minutes approximately; results are not affected by educational status, immigrant status, and language used; however, age and gender have significant effect on results.