Levent Sütçigil

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors

To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor (SSRI) treatment.

Weight gain in risperidone therapy: investigation of peripheral hypothalamic neurohormone levels in psychotic patients.

Abstract The use of antipsychotic drugs has started a new era in the treatment of psychotic disorders. Nevertheless, they cause complications in the long-term treatment, which is mainly weight gain. In this study, we investigated circulating levels of hypothalamic neuropeptides, which are related to appetite regulation, neuropeptide Y (NPY), &agr;-melanocyte-stimulating hormone (&agr;-MSH), cocaine- and amphetamine-regulated transcript (CART), and leptin, in first-attack psychotic patients who were treated with an atypical antipsychotic drug, risperidone, for 4 weeks. We used a case-control association design to compare the neuropeptides in the control group versus before and after treatment of the patient group. Samples were obtained from psychotic patients who were admitted to the Psychiatry Outpatient Clinics, Gulhane School of Medicine, Ankara, Turkey. When compared with the control group, NPY and &agr;-MSH plasma levels of psychotic patients were severely reduced, and the CART levels were substantially increased when they were first diagnosed (before treatment). However, the patients’ body mass index and circulating leptin levels were markedly high after the treatment. Circulating levels of those neurohormones were not significantly changed between before and after treatment of the patients. These data demonstrate that peripheral &agr;-MSH and NPY, although reflecting only secretion from peripheral organs, nevertheless, may provide an insight into the patients sympathetic tone and also suggest change of their appetite regulation. &agr;-Melanocyte-stimulating hormone, NPY, and CART plasma levels may be used as a predictor of weight gain in the early treatment of the patients along with the leptin levels.

Communication skills training for emergency medicine residents.

Objective To determine the effects of a communication skills training program on emergency medicine residents and patient satisfaction. Materials and methods Twenty emergency medicine residents attended a 6-week psychoeducation program that was intended to improve their communication skills. The first three sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between doctors and patients in the emergency department. Results The mean communication skills score increased from 178.7±19 to 189.2±16 after training (P<0.02). Empathy score also increased from 29.5±9 to 30.7±8, but this difference was not statistically significant (P=0.1). The patient satisfaction survey of 576 patients demonstrated increased scores on confidence in the doctor (88.2±14.6–93.6±10.3; P<0.01); the doctors respect, kindness, and thoughtfulness (90.3±10.8–94.1±16.5; P<0.01); individualized attention (86.7±9.4–93.9±11.1; P<0.01); devotion of adequate time to listening (88.6±12.3–90.8±14.1; P=0.04); and counseling and information delivery (90.1±11.3–92.2±11.7; P=0.02). The number of undesirable events between doctors and patients decreased 75% from 12 to three. Conclusion Participation in a communication skills training program was associated with improved communication skills of emergency medicine residents, increased patient satisfaction, and decreased complaints.

Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey

Objective. Characteristics of insomnia symptoms in Turkey are not well established. The goal of this study was to determine the prevalence of insomnia and related symptoms in an urban district of Turkey. Method. The study was carried out in Ankara, in an urban district with a population of 2665. Out of the 1332 people in the sample, 1034 in the 15–65 age range were included in the study. Interviews were conducted according to the “Sleep Disorders Assessment Questionnaire” developed by the researchers. The Insomnia Severity Index (ISI) was also given to the subjects with a sleep problem to measure the subjective quality and quantity of insomnia symptoms. Results and conclusion. A total of 29.4% of all participants reported a sleep problem, out of which 23.7% defined one or more of the insomnia symptoms which included difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), non-restorative sleep (NRS) and sleep deprivation (SD). Insomnia risk was found to be significantly increased with age, female sex, smoking and chronic medical illness. A total of 75.9% of participants who reported insomnia symptoms did not seek medical help for their complaint. According to the ISI, among the subjects with insomnia symptoms, 79 (32.2%) had subthreshold insomnia, 43 (17.6%) had clinical insomnia, 12 (4.9%) had severe clinical insomnia, while 88 (35.9%) did not score in the range indicating insomnia. The findings are discussed in the light of previous research and in relation to sociocultural factors emphasizing the need for public education on sleep disorders as medical conditions.

2761 – The role of central neuropeptides in weight gain caused by olanzapine

Introduction The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus. Objectives and methods In this study, the altereration of the ARC neuropeptide/hormone levels in rats were determined as one of the weight gain mechanism. To examine olanzapines weight gain effects, olanzapine was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides. Results and conclusions Food consumption was found to be increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and α-MSH decreased significantly but CART levels were also reduced unexpectedly. In conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain due to olanzapine therapy.

Şizofreni hastalarında ilk atakta P300 bulguları ile nörolojik silik işaretler arasındaki ilişki / Relationship between P300 findings and neurological soft signs in patients with first episode schizophrenia

Relationship between P300 findings and neurological soft signs in patients with first episode schizophrenia Objective: In this study, the relationship between neurological soft signs and P300 components was explored in patients with schizophrenia. Method: 22 first-episode schizophrenia patients who were evaluated according to DSM-IV criteria and whose disease lasted at least six months, and a group of 22 healthy controls were included in this study. In both groups, neurophysiological measurements were performed to investigate the P300 potentials and Neurological Evaluation Scale (NES) was applied to detect neurological soft signs. Scale for the Assessment of the Negative Symptoms (SANS) and Scale for the Assessment of the Positive Symptoms (SAPS) were applied only to the schizophrenia group. Results: Results revealed that first episode schizophrenia group had higher NES total and subscale scores, lower P300 amplitude and longer P300 latency compared to healthy controls. NES scores with the highest significant difference from healthy controls were Total NES and NES motor sequencing subscale. When the first-episode schizophrenia group is compared with the control group by the P300 components, difference of P300 amplitude was more significant than difference of P300 latency. It was also found that NES scores and P300 values were not correlated with clinical variables in the patient group. Conclusion: These findings indicate that pathology of these biological markers was found at the beginning of the disease and was not effected by clinical variables. This result can be interpreted as the pathologies exhibited with NES and P300 measurements could not be state but trait characteristics. Within soft neurological signs the most pathological results were obtained from motor sequencing subscale and its relationship with P300 amplitude was statistically significant. These findings indicate that the high scores of motor sequencing subscale which is thought to be sign of prefrontal pathology can be better explained with problems about attention.