Gozde Gultekin

Does plasma phoenixin level associate with cognition? Comparison between subjective memory complaint, mild cognitive impairment, and mild Alzheimer's disease

BACKGROUND Alteration in energy expenditure or metabolism is the most accused risk issue for the onset and for the course of neurodegenerative cognitive disorders. Neuropeptides are suggested to be related with learning and memory. Phoenixin (PNX) is the most recently reported neuropeptide and we aimed to compare the plasma level in people with subjective memory complaints, patients with mild cognitive impairment, and mild Alzheimers disease (AD). METHODS Ninety two participants enrolled in the study. After screening tests, all participants were assessed with a neuropsychological battery for further cognitive evaluations. We used ELISA kit to assay the level of Human PNX. RESULTS Patients with AD were significantly older than people in subjective memory complaint group (p = 0.02). There was no significant difference between groups according to gender (p = 0.435). Mean plasma PNX level was not significantly different between groups (p = 0.279). Mean plasma PNX level in MCI group was positively correlated with BMI (r = 0.402 and p = 0.028), serum HDL level (r = 0.454 and p = 0.012), blood systolic pressure (r = 0.428 and p = 0.018) and negatively correlated with logical memory (r=-0.335 and p=0.031). The mean plasma PNX level was positively correlated with immediate recall in subjective memory complaint group (r = 0.417 and p = 0.034). CONCLUSION This study is the first studying the association of plasma PNX level and cognitive complaints or decline. The knowledge about the role, interaction, and physiological functions of PNX is lacking. Lower plasma PNX level might be important in prodromal stages as MCI and the predictive role of PNX should be investigated in further studies.

Level of serum thioredoxin and correlation with neurocognitive functions in patients with schizophrenia using clozapine and other atypical antipsychotics

Thioredoxin is a serum antioxidant that has been investigated in the etiology of schizophrenia. The aim of this study is investigating the relationship between serum thioredoxin levels and cognitive functions in acute psychotic episode and remission state patients with schizophrenia; and examining whether there were differences between patients using clozapine and other atypical antipsychotics; including risperidone, olanzapine and amisulpride. This research was performed in schizophrenia patients hospitalized with acute psychotic episode (n=57), reevaluated patients after the initiation of treatment (mean 16 weeks) (n=46), and healthy controls (n=41). Positive and Negative Syndrome Scale, Clinic Global Impressions Scale, Neuropsychologic test battery to assess cognitive performance, and serum thioredoxin levels measured by ELISA were used in this research. Serum thioredoxin levels were highest in acute psychotic episode, lower in the remission state and the lowest in healthy controls. Significant correlation has been established between serum thioredoxin levels and Trail Making Test-A performance in remission state patients. In conclusion, serum thioredoxin levels were increased in acute psychotic episode and decreased in remission state, and its relationship with attention is worth to consider in schizophrenia patients.

The relationship between sluggish cognitive tempo and burnout symptoms in psychiatrists with different therapeutic approaches

Burnout is a serious problem for psychiatrists that has implications for clinical practice and personal health. While burnout is known to affect cognitive functions, no studies have examined the relationship between sluggish cognitive tempo (SCT) and burnout. This study aimed to examine this relationship and related factors as socio-demographic, occupational environment in psychiatrists. Participants(n=201, aged between 25 and 52 years,57.7% female) completed socio-demographic information form, Maslach Burnout Inventory and SCT Scale. According to our results, we have shown that total burnout scores and emotional exhaustion (EE) scores were significantly higher in psychiatrists with SCT. SCT scores were positively correlated with mean total burnout, EE, and depersonalization scores. We did not find any differences between subgroups according to departments, therapeutic approaches and gender. In conclusion, we want to highlight that psychiatrists with SCT were more proneness to general burnout symptoms and were more emotionally exhausted regardless of their therapeutic approach or their profession as adult or child/adolescent psychiatrists.

Neutrophil and platelet to lymphocyte ratios in people with subjective, mild cognitive impairment and early Alzheimer's disease: Inflammation in cognitive impairment

The most common cause of dementia in the elderly is Alzheimer’s disease (AD). Studies have suggested that amyloid β leads to neuroinflammation by promoting synthesis of cytokines and pro-inflammatory mediators, and in turn, chemokines and cytokines induce the production of amyloid β. Mild cognitive impairment (MCI) is an intermediate state between normal ageing and dementia. Subjective cognitive decline (SCD) is also considered an early stage of subsequent cognitive impairment, and it carries a risk of developing into dementia. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are useful and cost-effective biomarkers that show peripheral systemic inflammation. In this study we aimed to explore the role of inflammation in subjects with mild AD, MCI, and SCD via the new potential inflammation markers of NLR and PLR. The study was conducted in the geriatrics and geriatric psychiatry outpatient clinics of the Medical School of Cerrahpasa between 1 January and 31 October 2015. All patients provided written informed consent before clinical assessment. The local ethics committee of Cerrahpasa Medical School approved the study. In the screening phase, after an unstructured interview conducted according to the Diagnostic and Statistical Manual of Mental Disorder, 4th edition (text revision), patients were assessed by the Mini-Mental State Examination, Clinical Dementia Rating Scale, Geriatric Depression Scale, and Hachinski Ischemic Scale. Statistical analyses were performed using SPSS version 16 for Windows (IBM SPSS Inc, Chicago, IL, USA). Significance was set at a P-value <0.05. The study sample consisted of 31 patients with mild AD, 30 with MCI, 31 with SCD, and 31 healthy controls. Sociodemographic characteristics of the groups are shown in Table 1. The NLR value was 2.38 0.81 for AD patients, 2.48 1.19 for MCI patients, 2.24 1.11 for SCD patients, and 1.85 0.80 for healthy controls. NLR was significantly higher in the AD and MCI groups when compared with control group (P = 0.006, P = 0.030, respectively). Pairwise comparisons between AD and MCI groups, AD and SCD groups, and MCI and SCD groups showed no significant difference in NLR (P = 0.757, P = 0.245, P = 0.381, respectively). PLR levels were lowest in the healthy controls (110.29 39.28) and had a rising tendency in AD (124.26 45.41), SCD (124.74 39.60), and MCI subjects (139.61 65.01). NLR, PLR, lymphocyte, neutrophil, and platelet levels are shown in Table 2. In our cross-sectional study, NLR was significantly higher in the AD and MCI groups than in the control group. Strikingly, the same significant difference was not observed between the SCD and control groups. Differences in PLR levels were insignificant among the four groups. The role of NLR in AD patients was first investigated by Kuyumcu et al., who found NLR to be significantly higher in AD patients than in controls. This study also proposed that NLR was a strong independent variable for predicting AD. A study by Rembach et al. evaluated the longitudinal status of NLR in AD, MCI, and healthy controls at baseline and at 18, 36, and 54 months; it reported that the increase in NLR is a function of age and weakly correlates with neocortical amyloid accumulation. In this longitudinal study, Rembach et al. observed that NLR did not significantly differ (except for 18 months) between AD patients and healthy controls after adjustment for age, sex and Apolipoprotein E (APOEε4) allele status. Although inflammation markers have been found to be associated with MCI, a recent meta-

Alexithymia in people with subjective cognitive decline, mild cognitive impairment, and mild Alzheimer’s disease

BackgroundBehavioral and psychological symptoms are widely accepted as accelerator factors in progression to dementia. Although alexithymia is closely related to normal aging process and poor neurocognitive performance, alexithymia has not been included in these symptoms yet.AimsHere, we aimed to investigate alexithymia features in people with prominent clinical memory complaints.MethodsThe participants (n = 82) were classified into three groups as: subjective cognitive decline (n = 30), mild cognitive impairment (n = 27), and mild Alzheimer’s disease (n = 25) after Mini-Mental State Examination, Clinical Dementia Rating Scale, neuropsychological test battery, Geriatric Depression Scale, and Hachinski Ischemic Scale. All participants were assessed with 20-item Toronto Alexithymia Scale.ResultsThe patients with mild Alzheimer’s disease and mild cognitive impairment have significantly greater alexithymia features than individuals with subjective cognitive decline in Toronto Alexithymia Scale (p < 0.05 for all). The alexithymia features in patients with mild Alzheimer’s disease and mild cognitive impairment did not significantly differ (p > 0.05, for all).DiscussionPeople who have objective cognitive decline seem to have more alexithymia features than people with subjective cognitive decline. Moreover, alexithymia features seem to be similar in people mild Alzheimer’s disease and in mild cognitive impairment.ConclusionAlexithymia might be an important searching domain of behavioral–psychological symptoms in people with cognitive problems beyond aging.

Temperament and Character Traits in Patients with Behçet’s Disease with/without Eye Involvement

ABSTRACT Purpose: Ophthalmic involvement may lead to permanent vision loss in 25% of cases in patients with BD and it is a main concern in the literature. Although several studies have been investigated, the etiology and the cause of the disease and attacks are not yet known. This study aimed to investigate the correlation between visual impairment and personal characteristics and social circumstances in patients with BD. Materials and Methods: A total of 153 patients with BD and age-and gender-matched 26 healthy control subjects completed the self-report Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and State and Trait Anxiety Inventory (STAI-S and STAI-T). We classified the study participants into three groups with respect to severity of eye involvement and one control group. Each group was compared with the other two study groups and control group. Results: According to TCI, we revealed that there was a trend in BD patients with eye involvement + poor prognosis having less disorderliness traits than BD patients with eye involvement + good prognosis (p = 0.016). The BD patients with eye involvement + poor prognosis had significantly lower attachment scores than BD patients with eye involvement + good prognosis (p = 0.005) and healthy controls (p = 0.005). The BD with eye involvement + poor prognosis had lower empathy scores than healthy controls (p = 0.002). In the way of average TCI parameters, only SD was statistically significant. In terms of subdimensions of TCI parameters, RD3, SD3, SD5, and C2 were shown to be statistically significant among some of the groups. Conclusion: BD patients with eye involvement were demonstrated to be more extravagant and socially disinterested. It may reflect that severe visual loss caused BD patients to be more systematic, depressive, self-contained, and exhausted. Considering psychological aspects of BD and its visual manifestations may contribute to helping these patients more effectively.

Differential effects of clozapine and risperidone on facial emotion recognition ability in patients with treatment-resistant schizophrenia

ABSTRACT Objective: Clozapine and risperidone are used for treatment-resistant schizophrenia and known to improve the positive and negative symptoms. However, there are some conflicts about effects on social cognition, which is measured with facial emotion recognition ability. The impairments in facial emotion recognition ability have frequently been in different stages of the illness and might have negative influences on psychosocial functioning. In the present study, we aimed to examine clozapine and risperidone effects recognizing facial emotions in patient with treatment-resistant schizophrenia. Methods: Thirty-four patients were screened for the study, and 19 patients were included. All patients were evaluated with Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia, and Functional Remission of General Schizophrenia Scale at baseline and after 16–20 weeks of clozapine (n = 12) or risperidone (n = 7) treatment. Furthermore, the Facial Emotion Recognition Test was performed before and after treatment. The test included the photos of four male and four female models (totally 56 mixed photos) with happy, surprised, fearful, sad, angry, disgusted, and neutral facial expressions from Ekman and Friesen’s catalog. Results: The mean dose of the index drug in clozapine group was 295.83 ± 103.26 mg/day. The mean positive (p = .002), negative (p = .050) general psychopathology (p = .002), and total score (p = .002) according to the PANSS were significantly improved after treatment. The mean dose of the index drug in risperidone group was 6.86 ± 1.57 mg/day. The mean positive symptom (p = .018) and total score (p = .041) were significantly improved after treatment but negative symptom scale (p = .396) and general psychopathology (p = .149) scores did not change. There were no significant differences between baseline and after treatment in clozapine and risperidone group according to the accuracy rate of facial emotion recognition expressions (p > .05 for each). At baseline phase, the patients were significantly impaired in recognizing disgusted faces in risperidone than those in clozapine group (p = .032) and it was significantly poorer after treatment with risperidone than with clozapine (p = .031). The patients responded significantly faster after the treatment to all facial emotions except for fearful faces (p = .355). Conclusions: Clozapine and risperidone were not found to have extensive effects on the ability to recognize facial emotions because of ineffectiveness to negative symptoms as in our study. We speculated that the higher dopaminergic receptor occupancy rate of risperidone in insular cortex than that of clozapine might be related with hypo-activation of insula that was associated with particular deficit in ability to recognize expressions of disgust in patients with schizophrenia. Impaired facial emotion recognition ability is present even in first-episode psychosis, which might be a trait marker in schizophrenia.

A Survey Focusing on Lucid Dreaming, Metacognition, and Dream Anxiety in Medical Students

INTRODUCTION The aim of this study was to examine the level of lucidity and its relation with metacognitive beliefs and dream anxiety in medical students. METHODS Nine hundred sixteen medical students were enrolled in the study. The participants were assessed with the Lucidity and Consciousness in Dreams Scale (LuCiD), the Metacognition Questionnaire-30 (MCQ-30), and the Van Dream Anxiety Scale (VDAS). RESULTS There was no significant difference in mean total lucidity score between females and males, but there were some significant sex differences in subscales of lucidity, and control was significantly higher in male students, while realism, thought, and dissociation were significantly higher in female students. In addition, females had more dream anxiety levels, higher total MCQ-30 scores, and higher cognitive confidence and uncontrollability scores according to Metacognition Questionnaire-30 than males. We also found that the mean lucidity level was positively correlated with the mean total metacognition score and the mean total dream anxiety level. DISCUSSION Our results suggest that female medical students tend to have more realistic dreams (p=0.018), have more logical thoughts during dreaming (p=0.011), and have a more dissociative experience during dreaming (p=0.028), while male medical students have more controlled dream events (p=0.002). There seem to be differences according to lucidity features between sexes, and the relationship between subdomains of lucidity and metacognition might lead to new therapeutic approaches to several psychiatric disorders such as anxiety disorders.