Demet Sağlam Aykut

The relationship between neutrophil-lymphocyte, platelet–lymphocyte ratio and cognitive functions in bipolar disorder

Abstract Objective: Inflammation is an important factor in pathophysiology of bipolar disorder. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) analysis are used to predict peripheral inflammation. The aim of this study is to calculate neutrophil–lymphocyte and platelet–lymphocyte ratios, which are inflammatory markers, and investigate their effect on cognitive functions in euthymic patients with objective bipolar disorder. Method: Twenty - eight patients with type-I bipolar disorder and 22 healthy controls matched for age, gender and educational status were included in the study. Neuropsychological tests were applied to all participants. Neutrophils, lymphocytes and platelets counts of the participants were measured and NLR and PLR were calculated. Results: There was a significant negative correlation between NLR and Stroop interference score in study group. There was no statistically significant difference in NLR and PLR between study and control group. No significant correlation was found between PLR and neurocognitive test scores. Conclusion: This study revealed negative correlation between NLR and Stroop interference scores. We need further prospective studies with larger sample size to investigate role of inflammation on cognitive functions.

A retrospective analysis of cases with neuroleptic malignant syndrome and an evaluation of risk factors for mortality

Objective Neuroleptic malignant syndrome (NMS) is a neurological emergency rarely encountered in clinical practice but with a high mortality rate. Cases associated with atypical antipsychotic use or termination of dopamine agonists have been seen in recent years. The purpose of this study was to assess the presence of risk factors for mortality by investigating all clinical and laboratory characteristics of cases with NMS. Material and methods This descriptive, cross-sectional study retrospectively investigated all clinical and laboratory characteristics by scanning the ICD-10 codes of patients presenting to the XXXX Faculty of Medicine Emergency Department and diagnosed with NMS between 2006 and 2016. Patients were divided into surviving and non-surviving groups, and the data elicited were subjected to statistical comparisons. Results The mean age of the 18 patients diagnosed with NMS was 46.9 ± 4.8 years, and 50% were women. In addition to antipsychotics among the drugs leading to NMS, the syndrome also developed as a result of levodopa withdrawal in three patients and metoclopramide use in one patient. Statistically significant differences were determined between the surviving and non-surviving patients in terms of blood pressure, blood urea nitrogen (BUN), creatine kinase (CK) and mean platelet volume (MPV) values (p ≤ 0.05). Conclusion In this study the most common agent that cause NMS was atypical antipsychotics. Also advanced age, increased blood pressure and serum CK, BUN and MPV values were identified as potential risk factors for mortality in NMS.

A comparison of depot and oral atypical antipsychotics in terms of metabolic syndrome markers

ABSTRACTOBJECTIVES: The duration of life of patients with schizophrenia is shorter than that of the general population for various reasons. Especially cardiovascular diseases are one of the most important causes of death in patients with schizophrenia. Our aim in this study is comparison of second-generation depot antipsychotics and second-generation oral antipsychotics used in the treatment of patients with schizophrenia in terms of metabolic syndrome criteria.METHODS: We included 39 patients treated with second-generation depot antipsychotics and 124 patients treated with second-generation oral antipsychotics, who were diagnosed with schizophrenia. Positive and Negative Syndrome Scale was applied to all the patients and blood pressure, weight, height, body mass index, waist circumference, fasting blood glucose, triglyceride level, and high-density lipoprotein (HDL) levels were recorded.RESULTS: In terms of metabolic syndrome criteria, the waist circumference and triglyceride levels of the patients treat...ABSTRACT OBJECTIVES: The duration of life of patients with schizophrenia is shorter than that of the general population for various reasons. Especially cardiovascular diseases are one of the most important causes of death in patients with schizophrenia. Our aim in this study is comparison of second-generation depot antipsychotics and second-generation oral antipsychotics used in the treatment of patients with schizophrenia in terms of metabolic syndrome criteria. METHODS: We included 39 patients treated with second-generation depot antipsychotics and 124 patients treated with second-generation oral antipsychotics, who were diagnosed with schizophrenia. Positive and Negative Syndrome Scale was applied to all the patients and blood pressure, weight, height, body mass index, waist circumference, fasting blood glucose, triglyceride level, and high-density lipoprotein (HDL) levels were recorded. RESULTS: In terms of metabolic syndrome criteria, the waist circumference and triglyceride levels of the patients treated with the second-generation depot antipsychotics were lower than those of the patients treated with second-generation oral antipsychotics, and the HDL levels were statistically significantly higher. CONCLUSION: In this study, second-generation depot antipsychotics used in the treatment of schizophrenia patients were found to be associated with more positive results in terms of metabolic syndrome criteria than oral antipsychotic drug forms.

Acute urinary retention after alprazolam use: a case report

ABSTRACT Urinary retention is a condition in which impaired emptying of the bladder results in postvoid residual urine. Urinary retention has been well studied in observational studies and randomized controlled trials; data on the incidence of drug-induced urinary retention are scarce. In this article, a case of acute urinary retention developed after the use of alprazolam was discussed. A 67-year-old male underwent a prostatectomy operation for benign prostatic hyperplasia one month ago. Insomnia and dysphoria in the patient after the operation and alprazolam 1 mg/day was started. The patient started voiding problem after alprazolam treatment. No organic pathology was found to explain the table of existing urinary retention. The patient’s complaints resolved completely after alprazolam treatment stopped. We should be more careful about drug-induced urinary retention. When prescribing a drug to a patient, a thorough knowledge of its mode of action, adverse effects and potential drug interactions are important in preventing drug-induced urinary retention, especially in patients who have other risk factors for urinary retention.

Pulmonary thromboembolism associated with quetiapine: a case report

ABSTRACT Venous Thromboembolism (VTE), which includes pulmonary embolism and deep-vein thrombosis is also a potentially fatal adverse drug reaction and little attention has been focused on this topic. Atypical antipsychotics are associated with an increased risk of pulmonary embolism. In this case we want to show pulmonary thromboembolism associated with quetiapine. A 36-year-old man with bipolar disorder, presented to the Emergency Department complaining of epileptic seizure, general weakness, mild fever, and dizziness. Pulmonary thromboembolism was considered as the result of clinical evaluation. There were no risk factors such as age, smoking, trauma, immobilization, surgery, heart disease, and genetic risk factors to explain pulmonary embolism. In this case we see that the pulmonary embolism was associated with quetiapine. We should be more careful about pulmonary thromboembolism. Physicians and individuals must be aware of this potentially fatal, though treatable, adverse drug reaction when starting treatment, especially in patients who have other risk factors for VTE.Venous Thromboembolism (VTE), which includes pulmonary embolism and deep-vein thrombosis is also a potentially fatal adverse drug reaction and little attention has been focused on this topic. Atypi...

Antipsychotics, chlorpromazine and recurrent priapism: a review over a case

Priapism is a rare urological emergency characterized by painful erection exceeding 4-6 h and generally occurring independently of sexual desire and sexual relations. The etiology is broad and various. The ischemic type represents 95% of all cases of priapism. No cause is determined in 60% of cases of ischemic priapism, while hematological diseases, a history of drug use, malignity or a history of neurological disease can be identified in 40%. The drugs most commonly associated with priapism are antipsychotics, antidepressants, anticoagulants and antihypertensives. Although antipsychotic agents are implicated in 15-26% of cases of priapism, the mechanism involved in drug-associated priapism is unclear. The peripheral alpha 1 blocking activities of psychotropic agents or central serotonin-like activities are, however, implicated. The phenothiazine group antipsychotic agents chlorpromazine and thioridazine have the highest alpha adrenergic activity and are the antipsychotics most reported in association with priapism. Chlorpromazine is an antipsychotic with high alpha 1 antagonistic activity, and cases of priapism associated with use of chlorpromazine at varying doses and for varying durations have been reported. In this case report, the priapism in the patient with schizoaffective disorder is associated with intramuscular injection of chlorpromazine, in this regard the priapism cases and predictive factors in the literature is reviewed for the aim of increasing the sensitivity of clinician across the adverse effects of drugs and the importance of adequate psychiatric history and medical history taking and registering adverse effects of drugs is emphasized.

A case of osteogenesis imperfecta presenting with psychotic symptoms

Osteogenesis imperfecta (OI) is regarded as a heterogeneous clinical condition. Genetic complexity and extensive phenotypic variation lead to heterogeneous clinical manifestations in the condition. A 33-year old, male underwent consultation because of irritability, reference ideas and aggressive behavior. OI type-IV was diagnosed on the basis of physical examinations and radiological findings. Psychotic symptoms improved following low-dose antipsychotic treatment. This report presents a rare case of OI with psychotic symptoms. Comorbidity of a psychiatric disorder and OI in a case with a positive family history for both may also emphasize a common genetic basis between the psychotic disorders and OI.

Comparison of levels of serum nitric oxide and asymmetric dimethylarginine levels in manic episodes in bipolar affective disorder before and after the treatment

Objective: Function of NO and its intra-system competitive inhibitor of the nitric oxide, asymmetric dimethylarginine (ADMA) has been investigated in mood disorders, schizophrenia, autism, obsessive compulsive disorder and Alzheimer Disorder and significant results were obtained. The mechanism of action in mood stabilizators is still unclear despite many years of studies. The parameters of oxidative stres were shown to decreased upon antimanic treatment in bipolar affective disorder (BAD). The lithium may be suggested to produce neuroprotective effects against oxidative damage by regulatory effects towards various targets. The effects of lithium on nitric oxide synthase were researched in laboratory studies. In this study, two tubes of plasma were taken from the patients for determination of NO and ADMA during manic and euthymic phases. Methods: Seventeen patients who presented to the psychiatry or emergency departments of Farabi Hospital of Karadeniz Technical University and were diagnosed with BAD-I manic episode and followed with lithum were included into the study. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), were applied. For determination of NO and ADMA levels, two tubes of plasma were collected during the periods of mania and euthymia in the patient group. Results: The level of ADMA were significantly lower while the level of NO were higher in the posttreatment group than the pretreatment group. Conclusion: In this study, the level of NO were increased, the level of ADMA were dicreased in response to lithium treatment, and the therapeutic effect of lithium may contribute this mechanism.

Adverse Effects of Medication and Quality of Life in Patients Receiving Second Generation Antipsychotics: A Comparison of Long Acting Injectable and Oral Therapies

OBJECTIVE Maintenance treatment with antipsychotic drugs for patients with schizophrenia is highly effective in decreasing the recurrence rate of the disease. In the current study, we aimed to compare long-acting second generation antipsychotic drug injections and oral forms of second generation antipsychotic drugs in terms of their adverse effects on quality of life. METHOD Forty-one patients receiving second generation antipsychotic drugs and 139 patients diagnosed with schizophrenia or schizoaffective disorder were treated with oral second generation antipsychotic drugs and enrolled in the study. All patients were evaluated with Positive and Negative Symptoms Scale (PANNS), extrapyramidal symptom rating scale (ESRS) and UKU, and Quality of Life Enjoyment and Satisfaction questionnaire (Q-LES-Q). RESULTS The impact of adverse effects of oral second generation antipsychotic drugs on the daily performance of patients with schizophrenia or schizoaffective disorder was found to be significantly higher than that of the long acting injection antipsychotic drugs. The quality of life of patients receiving long acting second generation antipsychotic drug injection was significantly higher when compared with that of the patients treated with oral second generation antipsychotic drugs. CONCLUSION The results of this study showed that the long-acting second generation antipsychotic injection treatment was superior to second generation oral forms of antipsychotic drugs in terms of adverse effects and measures of quality of life. Further studies with specific design and the supplementation of larger samples are needed.

Current clinical variables in schizophrenia cases with suicide attempt history

OBJECTIVE High suicide risk was shown to be related with depression and low quality of life in studies investigating clinical variables related to suicidal behavior. The aim of this study was to investigate the effects of a suicide attempt on clinical presentation by comparing sociodemographic variables, clinical signs, symptoms of depression, quality of life, social functionality, and reported adverse drug reactions in schizophrenic patients with and without suicide. METHOD Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social Functioning Scale (SFS), and Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) were administered to 115 patients with schizophrenia. RESULTS 44.3% of patients had at least one suicide attempt. Among sociodemographic variables, a family history of suicide, smoking, and total duration of disease were significantly higher in patients with suicide history than without. Scores of CDS and UKU subscores were significantly higher, and quality of life and social occupation in social functionality were significantly lower in patients with a history of suicide. In correlation analysis, CSD was negatively correlated with Q-LES-Q and independency/performance subscore of SFI, and positively correlated with UKU-Neurological subscore. DISCUSSION In line with this data, suicidal behavior may be suggested to affect clinical presentation and course characteristic of schizophrenic patients. Additional treatments towards factors that may impact on the clinical course and social support programs might be suggested for these patients.