Evrim Özkorumak Karagüzel

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 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.

Blood levels of agouti-related peptide (AgRP), obestatin, corticosteroid-binding globulin (CBG), and cortisol in patients with bipolar disorder (BD): a case–control study

ABSTRACT OBJECTIVES: Bipolar disorder (BD) is a chronic psychiatric disorder with a high prevalence of obesity. There are a number of hypotheses regarding the association between obesity and BD. One involves common neurobiological abnormalities, such as dysfunction in the hypothalamic pituitary adrenal axis and changes in secretions of orexigenic and anorectic peptides. The purpose of this study was to evaluate the blood levels of agouti-related peptide (AgRP), obestatin cortisol, and corticosteroid-binding globulin (CBG) and metabolic parameters in patients with euthymic BD, and to compare these to those of healthy controls. METHODS: Twenty-nine outpatients with BD type I admitted to the psychiatric clinic were consecutively enrolled and compared with 25 sex- and body mass index (BMI)-matched controls. RESULTS: There was a significant difference in AgRP, cortisol, and CBG levels between patients and the controls (p = .005, .021, and .034, respectively). AgRP and CBG did not correlate with any parameter in BD patients, but cortisol correlated with BMI. CONCLUSIONS: We conclude that BD patients have higher levels of AgRP, cortisol, and CBG than healthy controls with similar BMIs. This may represent a new insight into the neurobiology of BD.

Differences between autogenous and reactive obsessions in terms of metacognitions and automatic thoughts

Background Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions have been classified as autogenous obsessions and reactive obsessions on the basis of the cognitive theory of Lee and Kwon. The aim of this study was to investigate the differences between autogenous groups (AG) and reactive groups (RG) in terms of metacognition and automatic thoughts, for the purpose of investigating the differences of cognitive appraisals. Methods One hundred and thirty-three patients diagnosed with OCD were included in the study as the patient group. A control group was formed of 133 age, gender and education-matched healthy individuals. The OCD group patients were separated into subgroups according to the primary obsessions. The sociodemographic data, and the Yale–Brown Obsessive Compulsive Scale, Metacognition Questionnaire-30 (MCQ-30), Automatic Thoughts Questionnaire (ATQ), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores of the AG, RG, and control groups were compared. Results The MCQ-30 (total) and the subscales of MCQ-30 and ATQ scale points were seen to be significantly higher in the AG than in the RG and significantly higher in the RG than in the control group. In the reactive obsession group, the predictive variables of the ATQ points were determined to be MCQ-30 (total), BDI and BAI. In the autogenous obsession group, the predictive variables of the ATQ points were determined to be BDI and BAI. Conclusion In the current study, differences were determined between the AG and the RG in respect of metacognitions and automatic thoughts. In light of these results, the recommended grouping can be considered useful in the identification of OCD sub-types. There is a need for further studies to identify more homogenous sub-types of OCD. Future multi-centered studies of sub-typing with larger samples using more specific instruments to sub-type and dimensional evaluation will be useful for detailed evaluation and better understanding of the subject.

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.

The Relationship of Interleukin-18 and Interleukin-6 Levels with Cognitive Functions in Bipolar Disorder

OBJECTIVE Impairment in immune functions is proposed as a key factor in the cognitive decline in bipolar disorder (BD) however there is scarcity of research on the impact of inflammation on cognitive functions. Our aim is to compare IL-18 and IL-6 levels in BD patients and controls and to study the relationship between IL-18 and IL-6 levels and cognitive impairment METHOD: Thirty-six euthymic BD-I patients and 38 age, sex and educational level matched healthy controls were enrolled in the study. All participants were evaluated with neurocognitive tests. The plasma IL-6 and IL-18 levels of both groups were measured with ELISA kits. RESULTS There was no statistically significant difference between IL-6 and IL-18 levels of patient and healthy control groups. In the patient group, IL-18 level was positively correlated with completed categories score wheras there was a negative correlation with perseverative response and perseverative errors. Moreover IL-18 level was positively correlated with immediate recall, delayed recall and learning scores while there was a negative correlation with stroop interference scores. No correlation was found between IL-6 level and neuropsychological test scores in the patient group. CONCLUSION This is the first study that investigates the relation of IL-18 with cognitive functions. Possible detrimental or protective effects of IL-18 in BD is not yet clear, however the positive association of IL-18 level and neuropsychological test scores might indicate a neuroprotective role of IL-18 in the euthymic period of BD which is the closest state to physiological condition.

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.