Lale Gönenir Erbay

Is There Any Relation Between Pseudoexfoliation Syndrome and Alzheimer's Type Dementia?*

Abstract Purpose: To investigate the frequency of Alzheimer-related dementia in patients with pseudoexfoliation syndrome (PEX). Methods: Sixty-seven patients with PEX and 67 age-, gender-, and educational-background-matched control subjects were compared for the presence of Alzheimer-related dementia according to DSM- IV-TR. The effects of cataract, glaucoma, additional ocular and systemic disease on the dementia incidence were also evaluated in patients with PEX and the control group. Results: The frequency of Alzheimer-related dementia was higher in patients with PEX (p = 0.0001). The frequency of dementia in patients who had cataract was higher than in patients without cataract (p = 0.003). There was also an association between additional ocular disease and dementia (p < 0.05). However, there was no association between systemic disease and dementia (p > 0.05). Furthermore, there was no difference for the frequency of dementia between patients who had glaucoma or not among patients with PEX (p = 0.953). Conclusion: The increased frequency of Alzheimer-related dementia in patients with PEX is important and a possible association between PEX and Alzheimer’s disease could be present.

Effects of Electroconvulsive Therapy on Some Inflammatory Factors in Patients With Treatment-Resistant Schizophrenia.

Objectives Electroconvulsive therapy (ECT) is the most effective option for several psychiatric conditions, including treatment-resistant schizophrenia. However, little is known about the molecular mechanism of action of ECT. The link between inflammatory system and schizophrenia is the focus of recent studies. However, the impact of ECT on inflammatory functioning in this disorder remains elusive. Whether ECT could modulate inflammatory factors in patients with schizophrenia was examined. Methods Plasma levels of interleukin-4 (IL-4), transforming growth factor-&bgr; (TGF-&bgr;), myeloperoxidase (MPO), and nuclear factor-&kgr;B (NF-&kgr;B) activation were analyzed in 20 schizophrenic patients, mainly with resistant to antipsychotic medication disorders, and in 20 sex- and age-matched healthy controls. Disease severity was evaluated using the Brief Psychiatric Rating Scale. All patients were followed with measurement of the inflammatory factors before and after ECT treatment and compared with the controls. Results Patients with schizophrenia had markedly raised NF-&kgr;B and but decreased TGF-&bgr; levels compared with healthy controls. On the other hand, no significant differences were found for the levels of IL-4 and MPO levels. The clinical improvement during repeated ECT was accompanied by a gradual and significant increase in IL-4 and TGF-&bgr; level, but MPO and NF-&kgr;B activation were left unaffected. Increases in TGF-&bgr; were negatively correlated with the change in Brief Psychiatric Rating Scale scores after ECT. Conclusions It is shown that ECT, while increasing the anti-inflammatory response such as the levels of IL-4 and TGF-&bgr;, it did not affect the levels of MPO and NF-&kgr;B activation in this study.

Neurosteroid Levels in Patients with Obsessive-Compulsive Disorder.

Objective Changes in serum neurosteroid levels have been reported in stress-related disorders such as anxiety and depression, but not in patients with obsessive-compulsive disorder (OCD). We thus investigated such changes in patients with OCD. Methods We compared the serum levels of progesterone, pregnanolone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEA-S), cortisol and testosterone in 30 patients with OCD and 30 healthy controls. Results When male and female patients were evaluated together, DHEA and cortisol levels were significantly higher in patients with OCD than the control group. When the genders were evaluated separately, DHEA and cortisol levels were higher in female patients than the female controls. The increase in DHEA levels in female patients is likely an effect of the hypothalamic-pituitary-adrenal (HPA) axis. In contrast, cortisol levels in male patients were higher than the control group, while testosterone levels were lower. The increased cortisol and decreased testosterone levels in male patients likely involves the hypothalamic-pituitary-gonadal (HPG) axis. Conclusion These findings suggest that neurosteroid levels in patients with OCD should be investigated together with the HPA and HPG axes in future studies.

Testosterone levels of children with a diagnosis of developmental stuttering

Background Stuttering is defined as a disruption in the rhythm of speech and language articulation, where the subject knows what he/she wants to say, but is unable to utter the intended word or phrase fluently. The effect of sex on development and chronicity of stuttering is well known; it is more common and chronic in males. We aimed to investigate the relationship between developmental stuttering and serum testosterone levels in this study. Materials and methods In this study, we evaluated a total of 50 children (7–12 years of age); eight (16%) were female and 42 (84%) were male. Twenty-five children who stutter and 25 typically fluent peers with the same demographic properties (ages between 7 years and 12 years) were included in this study. The testosterone levels of the two groups were determined in terms of nanogram per milliliter (ng/mL) by enzyme-linked immunosorbent assay. The difference between the means of the two groups was analyzed. Results The medians of the testosterone levels of the stutterer and control groups were determined as 20 ng/mL (range =12–184 ng/mL) and 5 ng/mL (range =2–30 ng/mL), respectively. Testosterone levels of the stutterer group were significantly higher than in the control group (P=0.001). Besides, there was a significant correlation between the severity of the stuttering and testosterone levels in the stutterer group (P=0.0001). Conclusion The findings of this study show that testosterone may have an effect on the severity of developmental stuttering and on the clinical differences between sexes. However, further investigations are needed to show that testosterone may play a role in the etiology of developmental stuttering.

Relationship between childhood trauma and suicide probability in obsessive-compulsive disorder

The aim of this study is to assess the relationship between childhood trauma with the probability of suicide in obsessive compulsive disorders. Sixty-seven patients who were diagnosed with OCD were included in the study out of the patients who were admitted to Malatya Training and Research Hospital psychiatry outpatient clinic. The research data were collected using Yale Brawn Obsessive Compulsive Scale (YBOCS), Beck Depression (BDS) and Beck Anxiety Scales (BAS), Childhood Trauma Questionnaire-28 (CTQ-28), and Suicide Probability Scale (SPS). CTQ was detected as ≥ 35 in 36 of 67 patients who were included in the study. Aggression (p = 0.003), sexual (p = 0.007) and religious (p = 0.023) obsessions and rituelistic (p = 0.000) compulsions were significantly higher in the group with CTQ ≥ 35. Mild correlation was detected between the SPS score and the scores of CTQ. Correlation remained even when the effect of BAS and BDS scores were excluded. At the end of our study, childhood traumas were found to be associated with obsessive symptoms. In the group with childhood trauma, increased suicide probability was detected independently from depression and anxiety.

Does Psychodrama Affect Perceived Stress, Anxiety-Depression Scores and Saliva Cortisol in Patients with Depression?

Objective Little is known about the effects of psychodrama group therapy on the level of stress, anxiety and depression of the group members, and the biological markers of stress. The aim of this study test cortisol level as a biological reflection of some mental characteristics gained by the psychodrama method in coping with stress. Methods Depressive patients aged between 18 and 65 years, who diagnosed with depression according to DSM-5, without psychiatric comorbidity, who do not use drugs and were available for psychodrama were enrolled into the study. These patients were evaluated using the Perceived Stress Scale, State-Trait Anxiety Inventory and Beck Depression Inventory. In order to observe the circadian rhythm of cortisol, samples were collected from the participants before lunch, before dinner and before going to sleep on the day before psychodrama and on the 0, 15th, and 30th minutes after awakening in the morning of the psychodrama day; as well as just before and after the psychodrama session. Saliva cortisol level just before the initial session of psychodrama group therapy was compared with the saliva cortisol level just after the last psychodrama session at the end of 16 weeks. Results Statistically significant difference was determined between the scores of perceived stress scale, STAI-1, STAI-2, beck depression inventory and salivary cortisol level before and after psychodrama session. There was significant decrease in both the scale scores and salivary cortisol after vs. before psychodrama. Conclusion This results is important as it shows the biological aspect of clinical improvement. Further studies would provide us with better understanding of the effects of psychodrama group psychotherapy on depressive mood and biological projections by means of short-term and long-term follow-up studies.

Sociodemographic and clinical characteristics of patients admitted to the consultation-liaison psychiatry clinic in a university hospital

Consultation-liaison psychiatry is an area of psychiatry researching the links between general medicine and psychosocial situations, and deals with the diagnosis, treatment and monitoring of psychiatric disorders and psychosocial problems accompanying physical diseases. The aim of this study is to review the sociodemographic data and treatment approaches for patients admitted to the consultation-liaison psychiatry unit of a university hospital within one year. The sociodemographic and clinical information for patients admitted to the consultation-liaison psychiatry unit of our hospitalÂ’s psychiatry ward from August 2015 to November 2016 were obtained by retrospectively investigating the hospital database and patient files and uploading the information to a structured form. Patients in the psychiatry ward were admitted by transfer with 64.9% from the clinic, 16.2% from the emergency service and 10.8% from other wards. The most common physical disease diagnosis of patients was neurologic diseases for 51.4%, endocrinologic diseases for 16.2% and other disease groups for 21.6%. The incidence of psychiatric diagnoses placed according to DSM-V were identified, in order, as psychotic disorders (18.9%), depressive disorders (16.2%), mental retardation (13.5%), somatic symptom disorders (13.5%), bipolar disorder (10.8%), personality disorders (8.1%), oppositional disorder (5.4%), anxiety disorders (5.4%), impulse control and behavior disorders (5.4%) and neurocognitive disorders (2.7%). A total of 10.8% of patients had suicidal thoughts, with 8.1% passive and 2.7% active. Inpatients admitted to our CLP unit, a high rate of 10.8% was identified to have suicidal thoughts. The association of increased suicide risk with many medical diseases shows the necessity of enquiring about suicidal thoughts for each patient. Cooperation between other clinics and CLP will be helpful in increasing the quality of service and offering a more holistic approach to these patients. It appears there is a need for broader cooperation in the area of consultation liaison. This data is considered to form a basis for future studies.

Urinary retention in male patient associated with aripiprazole

Urinary retention and / or voiding difficulty are a rare side effect caused by the second generation antipsychotics. Aripiprazole has a lower incidence of adverse effects than other second generation antipsychotics (SGA) and aripiprazole can be used as an alternative treatment on patients who have urinary retention depending on antipsychotic use. Although there are limited data in literature about the effect of aripiprazole on urinary retention, a case was encountered urinary retention with the use of antidepressants and aripiprazole together. Also there is only one case in the literature about urinary retention occurred with aripiprazole. Our case emerged urinary retention with the addition of aripiprazole while under treatment of paroxetine. Patient’s complaints have stopped with the discontinuation of aripiprazole and never emerged under treatment of paroxetine and risperidone. We aimed to contribute this case because there is limited data in literature about this subject. As a result, adrenergic, cholinergic, serotonergic, dopaminergic and histaminergic pathways have role on control of micturition but it is not clear that on which pathway aripiprazole acts on urination. However there is no symptom of urinary retention after stopping aripiprazole and adding risperidone, shows that there is a different mechanism associated with voiding in this case. Additional studies need to be done to clarify the mechanism.

Remission of Obsessive-Compulsive Symptoms in Hypomanic Period in a Patient with Comorbid Bipolar Affective Disorder and Obsessive Compulsive Disorder: A Case Report / Bipolar Affektif Bozukluk ve Obsesif Kompulsif Bozukluk Estanili Bir Olguda Hipomanik Donemlerde Obsesif-Kompulsif Belirtilerin Duzelmesi: Bir Olgu Sunumu

Given the prevalence rates of obsessive compulsive disorder and the bipolar affective disorders in the general population, one would expect the co-occurrence of these syndromes to be rare. Yet, findings have revealed extremely high rates of comorbidity in obsessive compulsive disorder with both depressive disorders (50%) and bipolar disorder (10%) and shown that obsessive compulsive disorder is the most common anxiety disorder in patients with bipolar disorder. This situation makes it difficult to recognize the changing clinical disease and prognosis while response to treatment can also be adversely affected. Clarifying the phenomenological features of obsessive compulsive disorder-bipolar affective disorder comorbidity has important etiological and treatment implications. In this article, we discuss the pathophysiological importance of the improvement of obsessive compulsive symptoms during hypomanic episodes in a bipolar disorder patient, who had comorbid obsessive-compulsive disorder.