Erdal Vardar

Increased serum tumor necrosis factor-alpha levels and treatment response in major depressive disorder.

RationaleOver the last 15 years, an increasing body of evidence has suggested a causal relationship between depression and the immunological activation and hypersecretion of pro-inflammatory cytokines, such as interleukin-1, interleukin-6 and tumor necrosis factor-alpha (TNF-α). However, little is known about the probable relationship of serum TNF-α with major depressive disorder (MDD).ObjectiveTo assess whether serum TNF-α levels could be associated with the clinical course of MDD.Subjects and methodsTNF-α and C-reactive protein (CRP) serum concentrations, erythrocyte sedimentation rate, and leukocyte count were measured in 26 MDD patients and in 17 controls. The measurements were repeated following 6 weeks of antidepressant treatment with selective serotonin re-uptake inhibitors. Psychopathological improvement and the severity of depression were evaluated with the Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI).ResultsOn admission, serum TNF-α and leukocyte count were significantly higher in MDD patients compared to controls (P<0.001 and P=0.005, respectively). With the antidepressant treatment, both HAMD and BDI scores decreased significantly (P<0.001 for both). Comparison of pre- and post-treatment measurements revealed that TNF-α, CRP, and leukocyte count decreased to levels comparable with those of the control subjects (P<0.001, P=0.01, and P=0.01, respectively).ConclusionsThe results emphasized that some immunological parameters, such as CRP, leukocyte count and TNF-α, are significantly involved in the clinical course and treatment response in MDD. TNF-α in particular could be considered as a potential state marker in MDD.

Psychological symptoms and sleep quality in young subjects with different circadian preferences

The aim of the study was to investigate the psychological features, sleep quality and daytime sleepiness of different chronotypes in healthy young participants. Seventy-nine female and 63 male medical students aged between 17 and 23 years (mean age: 19.8 ± 1.3 years) participated voluntarily in this study. They completed the Morningness-Eveningness Questionnaire, self-reported symptom inventory SCL-90-R, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Psychological symptoms and sleep features of morning types, evening types and intermediate types were compared with each other. Out of 141 subjects, 30 were evening types (21%), 34 were morning types (24%) and 77 were intermediate types (55%). Positive-symptom total scores of SCL-90-R were higher in the evening types than the morning and intermediate types. There were significant differences in the psychological symptoms of anxiety, obsessive-compulsiveness, hostility and phobia among these groups (p < 0.05). Total sleep quality was poorer and daytime sleepiness was significantly higher in the evening types than the morning and intermediate types (p < 0.05). Our findings suggest that evening chronotypes suffer from more anxiety, obsessive-compulsiveness, hostility and phobia symptoms, sleep problems and daytime sleepiness than the other chronotypes.

Egzersiz bağımlılığı ve psikopatolojik özelliklerinin değerlendirilmesi / Exercise dependence and evaluations of psychopathological features

Exercise dependence and evaluations of psychopathological features Objective: Exercise dependence has been described as making excessive physical exercise leading to clinically significant negative consequences. Self report scales were developed for the diagnosis of exercise dependence based on DSM-IV criteria. For the diagnosis, exercise frequency, psychological factors (e.g. pathological commitment), tolerance and withdrawal symptoms should be taken into consideration. However, the diagnosis of exercise dependence has been neglected because its definition is unsatisfactory and exercise dependent subjects do not seek any help. Secondary exercise dependence is defined as compulsive exercise occurring with eating disorders. The aim of this study is to investigate the exercise dependence in subjects practicing sports regularly and to evaluate the psychopathological features and disordered eating behaviors in the exercise dependent subjects. Method: One hundred fifteen voluntary subjects who had exercised regularly at least three times a week throughout the previous year were evaluated by Exercise Dependence Scale-21 (EDS-21), Symptom Check List 90-Revised (SCL-90-R) form and Eating Attitude Test (EAT-40). The subjects were categorized into three groups as exercise dependent, non-dependent symptomatic and non-dependent asymptomatic according to EDS-21 results and the groups were compared with each other. Results: Exercise dependence was present in 14 (12%) of all subjects. Of the exercise dependent subjects, 85% met the physiological dependence criteria. Exercise dependent group did not statistically differ from the other groups in terms of psychopathological symptoms and eating behavior. Conclusions: Our results showed that eating behavior and psychopathological features in exercise dependent subjects were not different from those of the non- dependent symptomatic and asymptomatic subjects. Exercise dependent subjects in the present study were categorized as having primary exercise dependence because they had no psychological and eating disorders symptoms. Psychological features and eating behavior should be evaluated together for the diagnosis of primary exercise dependence in subjects who exercised excessively and differential diagnosis should be made from the eating disorders.

Evaluation of sleep quality of early buprenorphine/naloxone treatment in opioid addicted patients

Objective: Opioid addiction is a chronic, relapsing and psychosocial disorder. In opioid addiction patients, studies show that sleep disorders, deteriorated quality of sleep and sleep architecture changes might be seen. In addition, comorbid psychiatric disorder and depression are frequently seen in opioid addicts. Comorbid psychiatric disorders and symptoms worsen of sleep quality in opioid addicts. This study aims to evaluate the quality of sleep during the periods of pre-treatment and in early opioid agonist maintenance treatment in the opioid addicts. Methods: The research included 29 patients in the Alcohol and Substance Addiction Treatment Unit of Trakya University Faculty of Medicine who have met diagnostic criteria for opioid addiction according to DSM-5, completed 28-day treatment, and admitted for control to Alcohol and Substance Addiction Treatment Unit after 1 month from discharge. The Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Pittsburgh Sleep Quality Index are administered to all the patients who participated to the study on the day 1, day 28, and in the month 2. All the patients were treated with buprenorphine and naloxone combination. Results: In our study, a time-dependent significant de-crease from day 1 to month 2 was determined in the average scores of the Pittsburgh Sleep Quality Index, which evaluates the sleep quality. In addition, the Pittsburgh Sleep Quality Index average scores showed differences in all time periods. Our study also determined a time-dependent significant decrease in the average scores of the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, which evaluates respectively the depressive symptoms and anxiety symptoms on the day 0, day 28 and day 60. Discussion: In our research, we evaluated the sleep quality and the symptoms of depression and anxiety of the patients diagnosed with opioid addiction in pre-treatment and early period of opioid agonist maintenance treatment, and showed that those symptoms were getting better with treatment. We think that these findings can guide further research, as they show that opioid treat-ment does not only serve for addiction treatment but also for the treatment of the symptoms accompanying the opioid addiction.

Substance Use and Parent Characteristics Among High School Students: Edirne Sample in Turkey

ABSTRACT The current study on substance use and family characteristics of adolescents is a part of the extensive research on substance use characteristics among high school students in Edirne, Turkey. This cross-sectional study was conducted with 8,483 high school students within the 2010–2011 academic year. Self-administered questionnaires were completed anonymously by the participants. The lifetime prevalence of alcohol use was 24.6% and tobacco use was 21.4%. The most commonly used illicit substance was cannabis (1%), followed by inhalants (0.5%) and ecstasy (0.4%). The use of alcohol, tobacco, and nearly all the illegal substances was significantly higher among males compared to females. The rates of lifetime substance use varied by family-related factors such as family structure, perceived parental attitudes and intrafamilial relationships, parental socioeconomic status, and parental substance use. The limitations and implications of these findings are discussed.

Aortic aneurysm and electroconvulsive therapy in elderly depressive patient.

We report the case of a 67-year-old single man with aortic aneurysm whose depression was successfully treated with electroconvulsive therapy. Metoprolol succinate was used for blood pressure control, and there were no cardiovascular side effects and no significant increase in blood pressure detected.