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QT wave dispersion in patients with panic disorder

ObjectiveQT dispersion (QTd), defined as the maximal inter-lead difference in QT intervals on 12 leads of the surface electrocardiogram (ECG), reflects the regional heterogeneity of ventricular repolarization and has been suggested as an important marker for risk of arrhythmia in addition to the QT interval. Some investigators proposed that it might be a predisposing factor for arrhythmic events and sudden death. Thus, we aimed to investigate whether QTd differs in patients with panic disorder from that in healthy controls.MethodsIn 40 panic disorder patients and 40 healthy controls, Qmax, Qmin, and QTd values were measured. In addition, the Hamilton depression rating scale and the panic agoraphobia scale were scored for both patients and healthy volunteers.ResultsQmax and Qmin values in the panic disorder patients were significantly higher than those in healthy controls. The mean corrected QTd was significantly greater in the patients than in the controls. One-way analysis of covariance (ANCOVA; using left atrial size, age and heart rate as covariates) also corrected the significant difference. In addition, ANCOVA revealed a significant main effect for the diagnosis, indicating a significantly higher QTd for patients compared with controls.ConclusionQTd might be associated with panic disorder. Future studies in larger samples evaluating the effects of treatment are required.

Temperament, character traits, and alexithymia in patients with panic disorder.

Background The primary aim of the present study was to compare temperament and character traits and levels of alexithymia between patients with panic disorder and healthy controls. Methods Sixty patients with panic disorder admitted to the psychiatry clinic at Fırat University Hospital were enrolled in the study, along with 62 healthy age-matched and sex-matched controls. The Structured Clinical Interview for DSM-IV axis I (SCID-I), Temperament and Character Inventory (TCI), Toronto Alexithymia Scale (TAS-20), and Panic Agoraphobia Scale (PAS) were administered to all subjects. Results Within the temperament dimension, the mean subscale score for harm avoidance was significantly higher in patients with panic disorder than in controls. With respect to character traits, mean scores for self-directedness and cooperativeness were significantly lower than in healthy controls. Rates of alexithymia were 35% (n=21) and 11.3% (n=7) in patients with panic disorder and healthy controls, respectively. The difficulty identifying feelings subscale score was significantly higher in patients with panic disorder (P=0.03). A moderate positive correlation was identified between PAS and TAS scores (r=0.447, P<0.01). Moderately significant positive correlations were also noted for PAS and TCI subscale scores and scores for novelty seeking, harm avoidance, and self-transcendence. Conclusion In our study sample, patients with panic disorder and healthy controls differed in TCI parameters and rate of alexithymia. Larger prospective studies are required to assess for causal associations.

Levels of serum immunomodulators and alterations with electroconvulsive therapy in treatment-resistant major depression.

Studies in recent years have indicated that neuroimmunological events and immune activation may have a place in the etiology of depression. It has been suggested from data that there is a causal relationship between activation of the immune system and excessive release of proinflammatory cytokines, such as interleukin 1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-alpha), and the etiology of depression. Although the mechanism of action of electroconvulsive therapy (ECT) is unclear, there is evidence that it can reduce cytokines and immune system changes. In our study, we aimed to determine how levels of serum immunomodulators were affected by ECT in major depression patients. This study was conducted on 50 patients with treatment-resistant major depression. The data of the patients were compared with 30 healthy individuals with similar demographic characteristics. A clinical response occurred in the patients and at the end of therapy, IL-1, IL-6, TNF-alpha, IL-10, IL-4, and interferon-gamma levels were measured. The disease severity was assessed with the 17-item Hamilton Depression Rating Scale. Data analysis was performed using SPSS Version 15. Significant differences were determined between the patients with major depression and control group with respect to basal serum IL-1, IL-6, TNF-alpha, IL-10, IL-4, and interferon-gamma levels. ECT treatment was shown to reduce these differences. ECT may cause significant changes in the activity of the immune system. The consideration of the relationship between the immune endocrine neurotransmitter systems could contribute to new theories regarding the mechanism of antidepressant treatment and biology of depression.

Serum levels of G protein-coupled estrogen receptor 1 (GPER1) in drug-naive patients with generalized anxiety disorder

Sex hormones, particularly estrogen, are suggested to play a role in the physiopathology of generalized anxiety disorder (GAD). Estrogen functions through the estrogen receptors alpha and beta and the recently discovered G protein-coupled estrogen receptor 1 (GPER1). This study aimed, for the first time, to evaluate serum GPER1 levels in drug-naive patients with GAD. This study included 40 newly diagnosed drug-naive patients with GAD aged between 18 and 50 years and 40 age- and gender-matched healthy controls. Medical histories were obtained, and physical examinations and laboratory tests were conducted; the Hamilton Anxiety Rating Scale (HAM-A) was also used for all participants. Serum GPER1 levels were measured. The serum GPER1 level was significantly higher in the patients with GAD than in the controls. A positive significant correlation was observed between the GPER1 level and the HAM-A score. The receiver operating characteristic analysis revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 85.0%, 82.5%, 82.9%, and 84.6%, respectively, for the presence of anxiety when the serum GPER1 value was ≥0.14 (the area under the curve was 0.904.). In conclusion, this study demonstrated that GPER1 levels were associated with the anxiety levels of patients, and that the serum GPER1 level was a valuable predictor of the presence of anxiety independent of gender.

P-wave and QT dispersion in patients with conversion disorder.

Objective The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive marker of ventricular arrhythmia and sudden cardiac death, and P-wave dispersion, which is the noninvasive marker of atrial arrhythmia, in patients with conversion disorder (CD). Patients and methods A total of 60 patients with no known organic disease who were admitted to outpatient emergency clinic and were diagnosed with CD after psychiatric consultation were included in this study along with 60 healthy control subjects. Beck Anxiety Inventory and Beck Depression Scale were administered to patients and 12-lead electrocardiogram measurements were obtained. Pd and QTd were calculated by a single blinded cardiologist. Results There was no statistically significant difference in terms of age, sex, education level, socioeconomic status, weight, height, and body mass index between CD patients and controls. Beck Anxiety Inventory scores (25.2±10.8 and 3.8±3.2, respectively, P<0.001) and Beck Depression Scale scores (11.24±6.15 and 6.58±5.69, respectively, P<0.01) were significantly higher in CD patients. P-wave dispersion measurements did not show any significant differences between conversion patients and control group (46±5.7 vs 44±5.5, respectively, P=0.156). Regarding QTc and QTd, there was a statistically significant increase in all intervals in conversion patients (416±10 vs 398±12, P<0.001, and 47±4.8 vs 20±6.1, P<0.001, respectively). Conclusion A similar relation to that in literature between QTd and anxiety and somatoform disorders was also observed in CD patients. QTc and QTd were significantly increased compared to the control group in patients with CD. These results suggest a possibility of increased risk of ventricular arrhythmia resulting from QTd in CD patients. Larger samples are needed to evaluate the clinical course and prognosis in terms of arrhythmia risk in CD patients.

Motivation for treatment in patients with substance use disorder: personal volunteering versus legal/familial enforcement.

Background Motivation for treatment on the part of patients with addictive disorders is known to affect their prognosis, and lack thereof is reported to be among the most common reasons for failed treatment adherence and relapse after treatment. This study evaluated the relationship between volunteering, personality, demographic factors, and motivation for treatment. Methods The study was conducted at a substance dependence center in the eastern part of Turkey. Forty-five patients (mean age 37.9±11.2 years) with a substance use disorder were included. They were assessed using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders) Axis II disorders. Depression and anxiety were evaluated using the Beck depression and anxiety inventories, and motivation for treatment was measured using the Turkish version of the Texas Christian University Motivation for Treatment scale. Results All patients had been using substances daily and 41 (88.9%) had been using multiple drugs. The most commonly used substance was heroin (n=18, 40%). Voluntary admission was a predictor of motivation for treatment (P<0.05). Having a personality disorder and higher depression scores were related to less motivation for treatment. Conclusion Motivation for treatment is affected by external factors such as type of admission and internal factors such as personality disorder and depression. Investigation of ways to encourage voluntary admission for treatment instead of enforced strategies may be helpful for achieving higher levels of motivation for treatment in substance users.

Psychiatric Symptoms and Psychosocial Problems in Patients with Breast Cancer

Cancer is a physical disease and also one of the leading clinical manifestations where psychosocial problems are prevalent. Psychosocial problems that these patients may have in the long run include anxiety, uneasiness, mourning, helplessness, fatigue, impairment of concentration, sleep disorders, mental and cognitive reservation, sexual dysfunction, infertility, psychological distress, and psychiatric disorders. Psychosocial problems have a nature of underpinning the emergence of psychological troubles. The prevalence of psychological disorders in patients with cancer range from 29% to 47%. Psychiatric disorders that are likely to be seen are severe stress disorder, adjustment disorder, depressive disorder, and other neurotic disorders. It is considered by the present author that in the event of breast cancer, potential psychiatric disorders may affect prognosis of the disease, adherance to and success of therapy, social and societal functioning, and survival rate. This paper aims to review the psychiatric symptoms and diseases that may develop in patients with breast cancer, which is one of the most frequent types of a globally common disease; i.e., cancer, as well as the impact of psychiatric symptoms on the treatment of disease.

The differences in temperament-character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I and II.

Background The primary aim of this study was to compare the differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I (BD-I) and bipolar disorder II (BD-II). Methods Fifty-two BD-I patients and 49 BD-II patients admitted to Erenköy Mental and Neurological Disease Training and Research Hospital psychiatry clinic and fifty age- and sex-matched healthy control subjects were enrolled in this study. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders, Temperament and Character Inventory, Barrett Impulsiveness Scale-11 (BIS-11), Hamilton Depression Inventory Scale, Young Mania Rating Scale, and Bipolar Disorder Functioning Questionnaire (BDFQ) were administered to patients and to control group. Results No statistically significant difference in sociodemographic features existed between the patient and control groups (P>0.05). Thirty-eight subjects (37.62%) in the patient group had a suicide attempt. Twenty-three of these subjects (60.52%) had BD-I, and 15 of these subjects (39.47%) had BD-II. Suicide attempt rates in BD-I and II patients were 60.52% and 39.47%, respectively (P<0.05). Comparison of BD-I and II patients with healthy control subjects revealed that cooperativeness (C), self-directedness (Sdi), and self-transcendence (ST) scores were lower and novelty seeking (NS1 and NS2), harm avoidance (HA4), and reward dependence (RD2) subscale scores were higher in patients with BD-I. When BD-I patients were compared with BD-II patients, BIS-11 (attention) scores were higher in patients with BD-II and BIS-11 (motor and nonplanning impulsivity) scores were higher in patients with BD-I. According to BDFQ, relations with friends, participation in social activities, daily activities and hobbies, and occupation subscale scores were lower and taking initiative subscale scores were higher in patients with BD-I. Social withdrawal subscale scores were higher in patients with BD-II. Conclusion In our study, NS, HA, and RD scores that may be found high in suicide attempters and Sdi scores that may be found low in suicide attempters were as follows: NS1, NS2, HA4, and RD2 subscale scores were high and Sdi scores were low in patients with BD-I, suggesting a higher rate of suicide attempts in this group of patients. In addition, C and Sdi scores that indicate a predisposition to personality disorder were significantly lower in patients with BD-I than patients with BD-II and healthy controls, suggesting a higher rate of personality disorder comorbidity in patients with BD-I. Higher impulsivity and suicidality rates and poorer functionality in patients with BD-I also suggest that patients with BD-I may be more impulsive and more prone to suicide and have poorer functionality in some areas.

Suicide Attempt, Suicidal Ideation and Hopelessness Levels in Major Depressive Patients with and Without Alexithymia

Suicide attempt, suicidal ideation and hopelessness levels in major depressive patients with and without alexithymia Objective: It is known that hopelessness and alexithymia levels are increased in patients with depressive disorder. In the literature, reports are suggesting that high levels of hopelessness in patients with depressive disorder increase suicide attempts and ideations. Here we aimed to investigate whether there are any differences in terms of suicidal ideation, suicide attempt and hopelessness levels in major depressive disorder patients with and without alexithymia. Method: In this study, 99 patients diagnosed with major depressive disorder according to structured interview for DSM-IV (SCID-I/CV) and 50 healthy subjects were included. Sociodemographic questionnaire, Toronto Alexithymia Scale (TAS-20), Beck Hopelessness Scale (BHS), Scale for Suicidal Ideation (SSI) and Hamilton Rating Scale for Depression (HRSD) were administered to patients and controls. Additionally, Suicide Intent Scale (SIS) was administered to patients with suicide attempt. Results: There was no significant difference in terms of sociodemographic data (except for the marital status) between major depressive patients with or without alexithymia and healthy controls. According to a cut off point of 61 for TAS-20, 34.3% (n=34) of the patient group was alexithymic and 65.7% (n=65) was non-alexithymic. Rate of suicide attempt was higher in the alexithymic major depressive patients (67.6%) than the non-alexithymic major depressive patients (29.2%). Mean scores of SSI and BHS were higher in alexithymic patients than non-alexithymic patients. There was a positive correlation between TAS-1 (difficulty identifying feelings), TAS-2 (difficulty expressing feelings) and BHS, SSI scores. Conclusion: In our study, suicidal ideation, suicide attempt and hopelessness levels were higher in major depression patients with alexithymia. Higher incidence of suicide attempts in major depressive patients with higher alexithymia levels and higher suicidal ideation and hopelessness levels in this group of patients suggest the possibility of alexithymia being a predictive factor for suicide attempt.

Schizophrenia-Like Psychosis and Dandy-Walker Variant Comorbidity: Case Report

Dandy-Walker variant is a developmental malformation consisting of cerebellar hypoplasia and cystic dilatation of the fourth ventricle. Previous research has proposed a possible role for the cerebellum in cognition and in schizophrenia. In this paper we report a schizophrenia-like psychotic disorder in a 30 year-old woman with Dandy-Walker variant. The patient was treated with risperidone 6 mg/day, biperiden 4 mg/day and risperidone depot 50 mg injections fortnightly, and most of the symptoms were ameliorated within 2 months. The similar cognitive profile to populations with cerebellar pathology and rarity of the condition strongly suggests that there may be direct relationship between cerebellar pathology and appearence of psychotic symptoms.