Evrim Özkorumak

Do the obsessive-compulsive symptoms have an effect in schizophrenia?

OBJECTIVE Schizophrenia presents with different symptom domains and functionality during its course. Obsessive-compulsive (OC) symptoms in schizophrenia have many themes to be clarified. Our aim was to compare schizophrenia patients with and without OC symptoms in terms of symptom domains, cognitive functions, and quality of life. METHOD Sixty-two patients who met schizophrenia diagnosis were assessed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition consecutively over a period of 12 months in the setting of an outpatient clinic at medical university hospital. Yale-Brown Obsessive-Compulsive Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and neuropsychologic tests were used. Quality of life was assessed with Quality of Life Scale for Patients with Schizophrenia. RESULTS Obsessive-compulsive symptoms along with schizophrenia were present in a considerable number in our sample (35.5%). Level of psychotic symptoms was more severe and quality of life was lower in schizophrenia patients with OC symptoms. A positive correlation was found between obsessions and delusions. Moreover, there was a positive correlation between compulsions and total Scale for the Assessment of Positive Symptoms score and bizarre behaviors subscore. There was no difference between the 2 groups regarding neurocognitive functions. The level of quality of life of schizophrenic patients with OC symptoms was lower. Besides, no correlation was found between OC symptoms and neurocognition and quality of life. CONCLUSIONS The findings of this study indicate that schizophrenia patients with OC symptoms had severe psychotic symptoms with a distinctive clinical picture including good neurocognition but poor functioning.

Personality traits of patients with multiple sclerosis and their relationship with clinical characteristics.

Abstract Few studies have investigated personality characteristics in people with multiple sclerosis (MS), and little is known about the relationship between personality and clinical characteristics in these patients. We aimed to investigate the personality traits of MS patients and their relationship with clinical characteristics. The study population consisted of 74 MS patients and age-matched, sex-matched, and education level–matched healthy controls. All participants were instructed to complete the self-administered 240-item Temperament and Character Inventory and the Beck Depression Inventory. The MS patients exhibited higher harm avoidance (HA) and lower self-directedness scores than the control group, although these differences disappeared after controlling for depression. Duration of the disease was positively correlated with HA and negatively correlated with novelty-seeking scores. Expanded Disability Status Scale scores were negatively correlated with reward dependence. Our results suggest a possible relationship between personality characteristics and the stage of the disease or the degree of damage in MS patients.

Siber Zorbalık ve Mağduriyetin Yaygınlığının ve Risk Faktörlerinin İncelenmesi

The aim of this study was to examine risk factors related to cyber bullying and victimization. The study was carried out with 160 adolescents applying to the Child/Adolescent Psychiatry Outpatient Clinic of the Faculty of Medicine of Suleyman Demirel University in Isparta, Turkey. Data was collected through using the Socio-Demographic Information Form, Internet Addiction Scale, and Cyber Victim and Bullying Scale. The results of the study showed that cyber bullying was related to gender, the risk of Internet addiction, the frequency of visiting Internet cafes, adolescents’ perception of their mothers’ Internet skills, the daily duration of visiting social networking sites, usage of the Internet predominantly to play online games, the monthly income of the family, and the mothers’ educational status. Cyber victimization, on the other hand, was found to be related to the risk of Internet addiction, the frequency of visiting Internet cafes, adolescents’ perception of their mothers’ Internet skills, and usage of the Internet predominantly to play online games. The results of the study were discussed in the light of relevant literature.

Evaluation of Temperament and Character Features as Risk Factors for Depressive Symptoms in Patients with Restless Legs Syndrome

Background and Purpose Restless legs syndrome (RLS) is a common sleep-related movement disorder that is frequently associated with psychological disturbances. Personality traits are of considerable importance with respect to coping with chronic illness and disease vulnerability. This study assessed the temperament and character traits of RLS patients using an approach that involves the psychobiological model of personality. Methods The personality features of 65 newly diagnosed and untreated RLS patients with no neurological or psychiatric diseases and 109 healthy controls were determined using the Temperament and Character Inventory and compared using covariance analyses. The International RLS Study Group Severity Scale was used to assess the severity of the RLS symptoms, and the Beck Depression Inventory was used to assess the presence and severity of depressive symptoms. Results RLS patients scored significantly higher than healthy controls on the temperament dimension of harm avoidance (HA, p=0.02) and significantly lower on self-directedness (SD, p=0.001). No significant difference was observed in terms of the temperament dimension of novelty seeking (p=0.435). HA scores were significantly correlated with the BDI score but not with the RLS severity or duration. Conclusions High HA and low SD scores are the main characterizing personality features of RLS patients. These personality dimensions may be among the factors predisposing patients to development of the depressive symptoms that are frequently associated with RLS.

A comparison of euthymic bipolar patients with unaffected first-degree relatives and healthy controls in terms of neuropsychological functions.

Abstract Objective. Cognitive dysfunction in bipolar disorder (BD) is well established in the literature. The neurocognitive deficits have been considered to be endophenotypic markers of BD, and studies have examined whether neurocognitive deficits exist in first-degree relatives of individuals with BD I. We hypothesized that performance in tests of neurocognitive function would be impaired in euthymic BD I patients and their unaffected first-degree relatives compared to that of healthy controls. Methods. We compared the performance of bipolar patients, their first-degree relatives, and healthy controls in a battery of neurocognitive tests to reveal possible endophenotypes of BD. A diagnostic interview and neuropsychological test battery were administered to 30 BD I patients, 55 of their unaffected first-degree relatives and 32 healthy controls. Results. The patients and their first-degree relatives were significantly impaired in executive function assessed using the Wisconsin Card Sorting Test (WCST) and Trail Making Test-B (TMT-B) relative to the controls (WCST; perseverative errors: p < 0.0005, categories completed: p = 0.002, TMT-B; p = 0.002). There were no significant differences between the groups in terms of attention, psychomotor speed, verbal memory, or learning. Conclusion. Our study suggests that the deficits in executive function may be endophenotypic markers of genetic vulnerability to BD I.

Trazodone induced galactorrhea: a case report

Trazodone is a heterocyclic antidepressant that exerts its effect via the inhibition of selective serotonin reuptake and the antagonism of 5-HT2A and 5-HT2C receptors. Antidepressant-induced galactorrhea and increases in prolactin levels have rarely been reported. Trazodone can potentiate the serotonergic activity of citalopram. To our knowledge, no cases of galactorrhea associated with use of trazodone have been reported to date. This report describes a unique case of the development of galactorrhea following the addition of trazodone (100 mg/day, 2 weeks) to the treatment of a patient who was receiving citalopram (40 mg/day, 6 weeks) therapy for a diagnosis of depressive disorder, which improved upon the discontinuation of trazodone.

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.

Mania induced by aripiprazole use: a case presentation

Mania induced by aripiprazole use: a case presentation Olanzapine, quetiapine and aripiprazole have been shown to be effective treatments for bipolar depression. However, induction of manic and depressive episodes with atypical antipsychotic treatments have also been described as risk. Current literature described antidepressant effects of Aripiprazole with the risk of manic shift. In this report, a case who developed manic episode with the treatment of 30mg/day of the aripiprazole will be discussed. A 35-year-old, woman, who had 12 years history of bipolar affective disorder-I (BAD-I) for 12 years, and taking paliperidone 9mg/day and lithium 1200mg/day for the last 14 months. She was admitted to outpatient clinic by her parents with complaints of fatigue, loss of pleasure and increased sleep. She was suspicious, had thoughts of getting harm form others and being a sinner, and suspecting that someone put a spell on her. She was admitted to inpatient service with the diagnosis of BAD-I depressive episode with psychotic features. Aripiprazole 30mg/day was added to current treatment regime. Consequently, increase in targeted activities, inappropriate affect, decreased need for sleep, and grandiose delusions were observed. The symptoms of mania were considered to be induced by aripiprazole, and its dose was decreased to 10mg/day. Following the dose reduction, sleepiness and her delusions were improved within the consecutive 2 weeks.

A Mania with Psychotic Features Upon Discontinuing Varenicline Therapy in a Patient with a Past History of Depression

Abstract Introduction Varenicline is an alpha 4 beta 2 nicotinic receptor partial agonist with dopaminergic effects, approved for smoking cessation. In May 2008, the FDA updated the previous Public Health Advisory and required that all patients should be observed and report to their physicians immediately for any mood or behavior changes, or worsening of preexisting psychiatric illness, during or upon discontinuation of varenicline therapy. Case presentation A 48 year old married woman with a history of major depression. She was in antidepressant treatment with 100 mg/day sertraline for 2 years and was euthymic for last 18 months. She never had symptoms of mania or hypomania. She had no family history of psychiatric illness. She was given a prescription by her doctor for varenicline, by dosing titrated to 1-mg BID by day 8. On day 14, she stopped smoking, with no withdrawal symptoms. She had no mood or behaviour changes during 12-week treatment period. At the end of 12 weeks, she was admitted to hospital with the diagnosis of mania with psychotic features. Conclusion There are case reports of mania in the context of initiating varenicline treatment, but this is the first case, to our knowledge, of a patient developing mania upon discontinuation of varenicline therapy. In this case we can suspect varenicline withdrawal may have contributed to the emergence of mania; however, this has not been reported in the literature. Also its possible that antidepressant-like properties of varenicline, may have potentiated the effect of sertraline and a manic shift occurred.

A cross-sectional analysis of patient characteristics and practice patterns in the management of bipolar disorder across Turkey -

Objective: Bipolar disorder (BD) is one of the leading causes of disability among medical and psychiatric disorders associated with prevalent, chronic, severe and highly disabling characteristics. This study was designed to identify clinical characteristics and practice patterns in the management of outpatients with BD across Turkey. Methods: This multi-center cross-sectional study involving 1001 patients diagnosed with using DSM-IV criteria was conducted prospectively at 31 outpatient psychiatry clinics for 12 months. Patient demographics, clinical features, family history, comorbid psychiatric disorders, and the treatment modalities were assessed by means of semi-structured questionnaire. Results: Age at the onset of symptoms was 26.7±9.8 years, age at diagnosis was 28.9±10.4 years, and the time interval between them was 2.2 (4.7) years. Misdiagnosis prior to current diagnosis was evident in 40.3% of bipolar patients. The most common type of first episode was mania (57.1%) and depression (34.5%). Comorbid psychiatric illness was identified in 12.0% of patients. Only 10% of patients were receiving monotherapy. The most commonly prescribed drugs for depressive, manic and mixed episodes were lithium, sodium valproate and quetiapine, respectively. Conclusion: The time interval between onset of symptoms and the initial diagnosis in Turkish sample was quite shorter than reported in the literature. The misdiagnosis rate in the present study and recent studies were similar. A low comorbidity rate appears to indicate a lower prevalence of comorbid disorders in BD in Turkish sample. Lithium, sodium valproate and atypical antipsychotics were more commonly used drugs in the treatment of BD in Turkey.