Esat Timuçin Oral

Minor hemoglobins HbA2 and HbF associate with disease severity in bipolar disorder with a likely protective role of HbA2 against post-partum episodes

BACKGROUND There exist studies indicating that bipolar disorder (BD) associates with changes in brain blood flow. Human brain with its high demand to oxygen constitutes 2% of the total body weight, while it receives 20% of cardiac output. α and β globin chains of hemoglobin were recently found in neural tissues, yet no study has questioned blood hemoglobins in BD. METHODS A total of 120 euthymic BD patients (40 males and 80 females) were analyzed via high performance liquid chromatography (HPLC) to measure minor hemoglobin levels, which were statistically compared with disease characteristics. RESULTS Minor hemoglobins HbA2 and HbF associated positively with episode density as a measure of disease severity in BD. An increased level of HbA2 meant significantly less postpartum episodes in child bearing women. HbF levels were higher in patients with a positive family history of any psychotic disorder. Sum of HbA2 and HbF correlated with episode density with a stronger significance (p<0.001) supporting intermittent hypoxia hypothesis in BD. LIMITATIONS The study was conducted only on euthymic patients to avoid likely bigger exogenous effects such as electro-convulsive therapy and diverse drug regimes, yet larger comparative studies are needed to support our current findings. CONCLUSIONS Higher HbA2 and HbF in more severe bipolar disorder may be compensations against intermittent hypoxias in BD. HbA2 increases following myocardial angina and in mountain dwellers, which may indicate protective roles in extreme conditions. HbF increase may act more as a maladaptation or emerge via haplotypal associations of BD genes and gamma-globin locus at 11p15.5.

Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey

Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance.

Kadın Sığınma Evinde Yaşayan Kadınlar İle Şiddet Gördüğü Evde Yaşamaya Devam Eden Kadınların Bağlanma Biçimlerinin Ve Ruhsal Belirti Düzeylerinin İncelenmesi / Attachment Styles And Psychological Symptoms Of Women Continue To Live İn The House They Were Subjected To Violence And Women Living İn Shelter Houses After The Violence

Attachment styles and degree of the psychological symptoms in women staying in a shelter for battered women or in their home where they were exposed to violence Objective: Surveys in Turkey revealed that one third of women were exposed to physical violence by their partners and 25% of them lost their lives. The rate of murdered women in the last seven years has increased more than 1400 times. These findings display the importance of the problem. This research has been planned to put forward the attachment styles and identify the psychological symptom levels of women who were subject to violence and living at shelters, and women who were living with their spouses. Methods: The sample of this study consists of 40 women who were subject to physical violence and continue to live with their spouses in the service area of Istanbul Metropolitan Municipality Counseling Centers, and 40 women who were subject to physical violence and living in three women’s shelters in Istanbul. Symptom Check List (SCL-90), Relationship Scales Questionnaire and socio-demographic form were used for research. Results: The comparison between these two groups were examined. Levels of symptoms related with somatization, obsessive-compulsive features, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, psychoticism, sleep and eating disorders, feelings of guilt were found high in both groups. The relationship between secured attachment styles and obsessive-compulsive features, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, psychotic and general symptom profiles showed statistically significant negative correlation. Conclusion: According to attachment styles, there were no significant statistical differences between women exposed to violence and living at women’s shelters and women who are exposed to violence but still living with their husbands; but the secure attachment style is higher in whom left their home at least once after the violence, comparing to women who never left the house. Besides, psychological symptoms were lower in women who were exposed to violence and had a secure attachment. Therefore, secure attachment style is a component for women to handle husband violence.

Quantiferon-tb Gold Test May Be More Advantageous Than Tuberculin Skin Test For Screening Latent Tuberculosis Infection In Psychiatry Clinics

Tüberküloz (TB) kontrol programlarında, yüksek riskli grupların tanımlanması ve takibi vazgeçilemez unsurlardandır. TB açısından yüksek riskli gruplar ≥100/100.000 ve üzeri insidans gösteren topluluklar olarak tanımlanmaktadır (1). Psikiyatri hastalarının da TB açısından yüksek riskli grup olduğu yapılan değişik çalışmalarda gösterilmiştir (2, 3). Latent tüberküloz enfeksiyonu (LTBE) tanısı yüzyıldan uzun bir süredir tüberkülin deri testi (TDT) ile konulmaktadır. Son yıllarda LTBE teşhisi için hem TDT’den daha özgül hem de sonuçları Bacillus-Calmette-Guerin (BCG) aşısından etkilenmeyen yeni diyagnostik testlerin kullanımı özellikle tüberkülozun sık görüldüğü ülkeler için önem kazanmıştır (4). Risk grupları ve temaslılarının araştırılmasında standart yöntem olarak TDT kullanılmakla birlikte bazı kısıtlanmalar bulunmaktadır. TDT’nin yanlış pozitiflik veya negatiflik vermesi ve yorumlama farklılıkları nedeniyle tanı ve yorumunda zorluklarla karşılaşılmaktadır (5). Pozitif TDT sonucu, M. tuberculosis, M. bovis, (BCG) ve pek çok tüberküloz dışı mikobakterilere (NTM) maruz kalma sonucu ortaya çıkabilmektedir. Ayrıca bağışıklığı baskılanmış olgularda yeterli immün yanıt oluşamadığından TDT testi yalancı negatiflik verebilmektedir (6). Son yıllarda LTBE teşhisi için hem TDT’den daha özgül hem de sonuçları BCG aşısından etkilenmeyen yeni diyagnostik testlerin kullanımı özellikle tüberkülozun sık görüldüğü ülkeler için önem kazanmıştır (7). Mikobakteri genomuna yönelik çalışmalar sonunda M. tuberculosis genomunda bulunan fakat BCG suşu ve NTM’lerin çoğunda bulunmayan farklılık bölgesi-1 (Region of Difference-1) (RD-1) tanımlanmıştır. Bu bölgede kodlanan ‘Early Secretory Antigenic Target-6’ (ESAT6) ve ‘Culture Filtrat Protein-10’ (CFP-10) antijenleri kullanılarak TB enfeksiyon teşhisi için T hücre yanıtına dayalı testler geliştirilmiştir (8). Ayrıca interferon-gamma (IFN-γ) salınım testleri aktif tüberkülozlu hastaların teşhisinde daha hassas bir yöntemdir ve test sonuçları LTBE olduğu düşünülen M. tuberculosis temaslı bireylerde daha iyi korelasyon sağladığını göstermektedir. Çalışmamızda uzun süreli kronik servislerde yatan ve tüberküloz salgını için yüksek risk grubu oluşturan 166 şizofreni hastasında LTBE sıklığı ile TDT ve QuantiFERON-TB Gold (QFT-G) testinin tanısal etkinliğinin karşılaştırılması hedeflenmiştir. Çalışmaya dahil olma kriterleri olarak daha önce aktif tüberküloz geçirmemiş, immünosupresif ilaç kullanmayan, antipsikotik tedavisi altında uzun süredir serviste yatan hastalar seçilmiştir. TDT ve QFT-G test sonuçları arasındaki uyumluluk k sabiti kullanılarak değerlendirilmiş ve her iki test sonuçlarının karşılaştırılması dört gözlü tablo kullanılarak yapılmıştır. Bu amaçla QFT-G ve TDT testi kullanılmış, TDT pozitifliği 99/166 (%59.63), QFT-G pozitifliği ise 88/166 (%53.01) olarak tespit edilmiş ve her iki test birbiriyle düşük derecede