Ihsan Aksoy

Electroconvulsive therapy in a catatonic patient with clavicle fracture

Karl Kahlbaum defined catatonia in cases of schizophrenia that had firstly ecopraxia, fluctuating stupor, negativism, posturing, stereotypy, automatic obedience, and mannerism. Electroconvulsive therapy (ECT) and benzodiazepines (BZ) are the effective treatment options in catatonia. Vertebral and long-bone fractures were common in ECT and ECT had a relative contraindication in patients with bone disease before the routine usage of muscle relaxants in ECT. Despite a reduction of the risk with modern ECT procedures psychiatrists concerns and fears about this issue are ongoing. ECT has been successfully performed in bone fractured and damaged patients. In this case report we presented a patient who had a clavicle fracture due to a traffic accident and simultaneously diagnosed with catatonia and had successfully treated with ECT and BZ.

Urinary Retention in an Adolescent Patient Caused by Fluoxetine Alone.

[Author Affiliation]Mehmet Karadag. Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Sahinbey, Turkey.Cem Gokcen. Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Sahinbey, Turkey.Hasan Bayar. Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Sahinbey, Turkey.Ihsan Aksoy. Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Sahinbey, Turkey.Address correspondence to: Mehmet Karadag, MD, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Sahinbey, Turkey, E-mail: mehmetkaradag1988@gmail.comTo The Editor:The 1 year prevalance of obsessive compulsive disorder (OCD) has been found to be as high as 4% in late adolescence (Douglass et al. 1995). Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) are recommended in its treatment. Fluoxetine is from an SSRI group that blocks the reuptake of serotonin by inhibiting serotonin transporters (SERT), and it also has a 5-HT2c antagonistic effect that enhances the release of both dopamine and norepinephrine. Fluoxetine was previously reported to cause urinating problems in combination with other drugs; however, to our knowledge, our case is the first one reporting similar side effects with fluoxetine alone.Case ReportA 17-year-old female patient was admitted to our clinic 1 year ago with complaints of repetitive thoughts and behaviors such as counting up to specific numbers and walking without treading on pavement lines because otherwise her loved ones could get hurt. Physical examination and laboratory test results were all normal. There was no history of medical comorbidity, including of urogenital diseases. Psychiatric evaluation suggested the diagnosis of OCD. Fluvoxamine treatment was titrated up to 200 mg/day. Fluvoxamine was stopped after 3 months because it was ineffective, and the patient was treated with sertraline 100 mg/day with risperidone 1 mg/day for 6 months by another psychiatry center, which was found to be ineffective. Fluoxetine 20 mg/day was started by the same center 1 month and she started to have difficulty urinating, in the first week of fluoxetine treatment. Her complaints had gradually increased to a point at which she had not been able to urinate for 2 days. …

Physicians’ attitudes toward home healthcare services in Turkey: A qualitative study

ABSTRACT Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress. Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians’ attitudes toward this service in detail. Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed. Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important. Conclusion: The current study underlines physicians’ interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

Phenprobamate dependence: A case report

Phenprobamate (3-phenylpropylcarbamate) is a centrally acting muscle relaxant with mild sedative and anticonvulsant effects. Muscle relaxants can enhance and prolong the effect of narcotic drugs and enable to obtain same effect with a smaller amount of alcohol or illicit substance. Almost all of the centrally acting muscle relaxants have varying sedative effects on which their abuse potential mainly depends. Data related to abuse of carisoprodol, meprobamate, baclofen takes place in the literature. However, to our knowledge this is the first case report about abuse of and tolerance to phenprobamate. We aimed to attract attention to important points of prescribing drugs that have abuse potential like in our case who was using up to 16000 mg/day phenprobamate.

Both typical and atypical long-acting injectable antipsychotics in bipolar disorder: a retrospective chart review -

Amaç: İkiuçlu bozukluk (İUB) tanı ve tedavi sürecinde zorluklar içeren ve kronik seyir gösteren psikiyatrik bir bozukluktur. İUB idame tedavisinde en büyük sorunlardan biri ilaç uyumunun sağlanmasıdır. Uzun etkili enjektabl (UEE) antipsikotikler bu tür hastalarda ciddi avantajlar sağlamaktadır. Biz bu çalışmada, tipik ve atipik UEE antipsikotikleri tedavi öncesi ve sonrasındaki bir yıllık dönemde klinik özellikler, hastane yatış sayıları ve yan etkiler açısından ayrı ayrı karşılaştırmayı amaçladık. Yöntem: Çalışma evreni Gaziantep Üniversitesi Duygudurum Birimi’nde takip edilen 802 İUB hastasından oluşturuldu. Bu hastalardan 80’i tipik ya da atipik UEE antipsikotik kullanıyordu. Çalışma kriterlerini karşılayan sadece 31 hasta çalışmaya dahil edildi. Etkinlik; tedavi öncesi ve sonrası bir yıllık dönem içindeki KGI, YMDÖ, HAMD skorları (12 ay önce, 6 ay önce, tedavi ekleme zamanı, 6 ay sonra ve 12 ay sonra), hastaneye yatış oranları ve ortalama yıllık hecme sayıları karşılaştırılarak değerlendirildi. Bulgular: Çalışma örnekleminde UEE antipsikotik kullanım oranı %9.88 olarak tespit edildi. İdame tedavide UEE antipsikotiklerin yıllık ortalama atak sayısını azalttığı ve depresyondan ziyade manik atağı önlemede etkin olduğu gösterildi. Atipik antipsikotiklerin YMDÖ ve KGI skorlarını anlamlı oranda azalttığı tespit edilirken HAMD skorlarında anlamlı bir değişiklik gözlenmedi. Tipik antipsikotikler ile ise ölçek skorlarının hiçbirinde anlamlı bir değişiklik görülmedi. Tipik ve atipik UEE antipsikotikler yan etkiler açısından tedavi öncesi ve sonrasında karşılaştırıldığında anlamlı bir farklılık saptanmadı. Tartışma: Çalışmamız bizim bilgilerimize göre, İUB’de atipik ve tipik UEE antipsikotiklerin birlikte dahil edildiği ilk çalışmadır. Sonuç olarak; UEE antipsikotiklerin manik atak korumasında etkin olabileceği ve yan etkiler açısından da tedavi öncesi ve sonrasında bir değişikliğin olmadığı gösterilmiştir. Hasta sayısı artırılarak yapılacak yeni çalışmalarla çalışmamızın sonuçlarının tekrar edilmesine ihtiyaç vardır.

Electroconvulsive therapy in a major depression patient with arachnoid cyst

Electroconvulsive therapy in a major depression patient with arachnoid cyst Arachnoid cyst develops when two layers of arachnoid membrane fail to unite in early fetal life causing cerebrospinal fluid accumulation and formation of a cyst. Arachnoid cysts constitute 1% of space occupying lesions in the brain. Diagnosis is made usually with regular medical examinations. They can cause epilepsy, increased intracranial pressure, neurological deficits, macrocranium and growth deficit in children, and subdural hematoma. It has been recommended to be careful when administrating Electroconvulsive therapy (ECT) to the patients with space occupying lesions. ECT can cause adverse effects in patients with arachnoid cyst by increasing intracranial pressure. Arachnoid cyst can rupture and give symptoms by causing subdural effusion, subdural hemorrhage or intracystic hemorrhage. In this case, we diagnosed major depression and arachnoid cyst. We administered ECT to the patient who had suicide ideation and was resistant to pharmacotherapy. Patient’s complaints fully recovered with ECT. The size of arachnoid cyst didn’t increase and we observed no complication. In this case, we aimed to show that ECT could be successfully administered to the patients with arachnoid cyst.