Murat İlhan Atagün

Investigation of Heschl's gyrus and planum temporale in patients with schizophrenia and bipolar disorder: A proton magnetic resonance spectroscopy study

BACKGROUND Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. METHODS Thirty patients with schizophrenia (38.67±12.46years of age), 28 euthymic patients with bipolar I disorder (35.32±9.12years of age), and 30 age-, gender- and education-matched healthy controls were enrolled. Proton magnetic resonance spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschls gyrus and planum temporale of superior temporal cortices. RESULTS There were significant abnormalities in glutamate (Glu) (F(2,78)=8.52, p<0.0001), N-acetyl aspartate (tNAA) (F(2,81)=5.73, p=0.005), creatine (tCr) (F(2,83)=5.91, p=0.004) and inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. CONCLUSION As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder.

Report on 3 years' experience in electroconvulsive therapy in bakirkoy research and training hospital for psychiatric and neurological diseases: 2008-2010.

Objective We present our 3 years’ experience with electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases (BAKIRKOY) ECT Center after modification of ECT regulations in Turkey. Also included in this article is a brief overview and discussion on ECT applications. Methods Bakirkoy medical records in electronic database were examined retrospectively (between January 2008 and December 2010), focusing on several aspects of short-term use of ECT: patient’s age, sex, and diagnosis; mean number of treatments per patient; duration of stay in hospital; percentage of ECT use in hospitalized patients; and frequency and types of adverse events. Results A total of 3490 patients hospitalized for acute conditions (2138 men and 1352 women) were treated with ECT in a period of 3 years, with a total of 27,660 ECT treatments performed. The total number of psychiatric patients hospitalized for acute conditions was 24,310 (14,132 men and 10,178 women) during the same period. The ratio of ECT use among acute care hospitalizations was 1:6.97 (14.36%). The mean ± SD age of patients treated with ECT was 35.02 ± 11.29. The mean ± SD number of ECT sessions was 7.89 ± 2.86. Affective disorders (46.99%) and psychotic disorders (52.12%) were among the leading diagnoses. No deaths occurred during ECT sessions, and no severe adverse events were observed. Conclusion The percentage of patients treated with ECT in BAKIRKOY is similar to rates reported in most Asian countries, which is higher than those reported in Western psychiatric centers. Absence of any life-threatening adverse effect or death, and presence of relatively few adverse effects, may be considered as an indication of conformity to current guidelines.

Comparison of Propofol, Etomidate, and Thiopental in Anesthesia for Electroconvulsive Therapy: A Randomized, Double-blind Clinical Trial.

Objectives This study aimed to compare the effects of propofol, thiopental, and etomidate, which are routinely used in anesthesia for electroconvulsive therapy (ECT), on the cardiovascular system, seizure variables, recovery, cognitive functions, and response to treatment. Methods Male patients hospitalized at the Seventh Psychiatry Clinics of the Bakırköy Teaching Hospital for Psychiatry, Neurology, and Neurosurgery who were treated with ECT were investigated prospectively. The effects on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables (duration and intensity of seizure), and recovery variables were recorded at every session, on prespecified time points, and the findings of the first session were used in this evaluation. In addition, clinical responses to treatment were evaluated with tests of cognitive functions before and after a course of ECT. Adverse effects were recorded. Results The sociodemographic characteristics of the 3 treatment groups were similar. There were no significant differences among the groups in terms of effects on cardiovascular system variables, seizure variables, and cognitive functions. The clinical response to ECT was good in all groups, without any significant differences. Conclusions Propofol, etomidate, and thiopental are associated with similar safety and efficacy profiles.

Lithium excessively enhances event related beta oscillations in patients with bipolar disorder

BACKGROUND Previous resting-state electroencephalography studies have consistently shown that lithium enhances delta and theta oscillations in default mode networks. Cognitive task based networks differ from resting-state networks and this is the first study to investigate effects of lithium on evoked and event-related beta oscillatory responses of patients with bipolar disorder. METHODS The study included 16 euthymic patients with bipolar disorder on lithium monotherapy, 22 euthymic medication-free patients with bipolar disorder and 21 healthy participants. The maximum peak-to-peak amplitudes were measured for each subjects averaged beta responses (14-28 Hz) in the 0-300 ms time window. Auditory simple and oddball paradigm were presented to obtain evoked and event-related beta oscillatory responses. RESULTS There were significant differences in beta oscillatory responses between groups (p=0.010). Repeated measures ANOVA revealed location (p=0.007), laterality X group (p=0.043) and stimulus X location (p=0.013) type effects. Serum lithium levels were correlated with beta responses. LIMITATIONS The lithium group had higher number of previous episodes, suggesting that patients of the lithium were more severe cases than patients of the medication-free group. DISCUSSION Lithium stimulates neuroplastic cascades and beta oscillations become prominent during neuroplastic changes. Excessively enhanced beta oscillatory responses in the lithium-treated patients may be indicative of excessive activation of the neuron groups of the certain cognitive networks and dysfunctional GABAergic modulation during cognitive activity.

Psychiatric morbidity in patients with vitiligo / Vitiligolu hastalarda psikiyatrik morbidite

Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine the frequency of psychiatric morbidity in vitiligo patients treated at the dermatology outpatient clinic and to investigate the relation between anxiety, depression, social anxiety levels, and self esteem and disability in these patients. Method: Fourty-two patients with vitiligo were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), Liebowitz Social Anxiety Scale (LSAS) and Sheehan Disability Scale (SDS). Control group included subjects matched to patients in terms of age, sex and education level. Results: In comparison to healthy controls, the rate of psychiatric morbidity was found to be higher and mean self-esteem score was found to be lower in the vitiligo group. There was no significant difference between groups in terms of social anxiety. Majority of the patients were mildly disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in female and young participants. Anxiety and social avoidance scores negatively correlated with age. Conclusion: These findings suggest that the rate of psychiatric morbidity is higher in patients with vitiligo than healthy control subjects. Patients with vitiligo treated at dermatology clinics should be assessed in terms of psychiatric disorders and psychiatric interventions may become necessary in the course of illness.

Neurochemical Differences Between Bipolar Disorder Type I and II in Superior Temporal Cortices: A Proton Magnetic Resonance Spectroscopy Study

BACKGROUND Despite the diagnostic challenges in categorizing bipolar disorder subtypes, bipolar I and II disorders (BD-I and BD-II respectively) are valid indices for researchers. Subtle neurobiological differences may underlie clinical differences between mood disorder subtypes. The aims of this study were to investigate neurochemical differences between bipolar disorder subtypes. METHODS Euthymic BD-II patients (n = 21) are compared with BD-I (n = 28) and healthy comparison subjects (HCs, n = 30). Magnetic Resonance Imaging (MRI) and proton spectroscopy (1H MRS) were performed on a 3T Siemens Tim Trio system. MRS voxels were located in the left/right superior temporal cortices, and spectra acquired with the single voxel Point REsolved Spectroscopy Sequence (PRESS). The spectroscopic data were analyzed with LCModel (Version 6.3.0) software. RESULTS There were significant differences between groups in terms of glutamate [F = 6.27, p = 0.003], glutamate + glutamine [F = 6.08, p = 0.004], inositol containing compounds (Ino) (F = 9.25, p < 0.001), NAA [F = 7.63, p = 0.001] and creatine + phosphocreatine [F = 11.06, p < 0.001] in the left hemisphere and Ino [F = 5.65, p = 0.005] in the right hemisphere. Post-hoc comparisons showed that the BD-I disorder group had significantly lower metabolite levels in comparison to the BD-II and the HC groups. LIMITATIONS This was a cross-sectional study with a small sample size. In addition, patients were on various psychotropic medications, which may have impacted the results. CONCLUSIONS Neurochemical levels, in the superior temporal cortices, measured with 1H-MRS discriminated between BD-II and BD-I. Although further studies are needed, one may speculate that the superior temporal cortices (particularly left hemispheric) play a critical role, whose pathology may be related to subtyping bipolar disorder.

Serum lithium levels are associated with white blood cell counts in bipolar disorder

* Correspondence: miatagun@ybu.edu.tr To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively in psychiatric disorders. Previous studies have reported alterations in the number (1,2) and function (3) of blood cells in psychiatric disorders. Alterations might be related to different etiologies in different psychiatric disorders (1) and medications (4,5). After the reversal of these mechanisms by successful treatment with escitalopram, the platelet volumes were normalized in first episode, medication-naive patients with major depressive disorder (6). In bipolar disorder, mood stabilizers seem to be the major reason for the changes in blood cells (4,5). In patients with psychotic spectrum disorders, the mean platelet volume (MPV) is increased, especially in patients on atypical antipsychotics (7). We have analyzed the blood cell counts of outpatients in our clinic between 1 January, 2012 and 31 December, 2014. Major depressive disorder (n = 338), bipolar disorder (n = 389), and psychotic spectrum disorders (n = 227) were the diagnostic groups examined in our analysis. The results of the comparison between the groups are presented in Table 1. These results confirm the previous study results, which reported increased leukocytes and decreased erythrocytes and platelets in bipolar disorder. Lithium (Li) increases the number of leukocytes in circulation (4,8–10). We further compared hematological parameters in patients on Li (n = 124), patients on valproate (VPA) (n = 203), and patients not taking a mood stabilizer (n = 51) in the bipolar disorder group (Table 2). Since Li and VPA have similar mechanisms of action, we proposed that VPA might also have effects similar to those of Li. However, there were differences in the platelet distribution width (which was higher in VPA-treated patients than in mood stabilizer-free patients with bipolar disorder, P = 0.006), platelet counts (which were lower in VPA-treated patients than in Li-treated patients (P = 0.000002) and mood stabilizer-free patients with bipolar disorder (P = 0.040)), WBCs (which were lower in VPA-treated patients than in Li-treated patients, P = 0.000076), and red blood cell counts (which were lower in VPA-treated patients Received: 30.05.2015 Accepted/Published Online: 13.09.2015 Final Version: 23.06.2016 Letter to the Editor

Ischemia-modified albumin: a unique marker of global metabolic risk in schizophrenia and mood disorders

ABSTRACT OBJECTIVE: Conformational change in the last four amino acid of the albumin’s N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p < 0.001) were the determinants of IMA levels with linear regression analysis. CONCLUSION: Elevation of IMA levels may indicate a global metabolic risk, and IMA levels are elevated in the BD group in this study. Determinants of IMA levels may indicate the significant metabolic risk in patient groups. Oxidative stress (OS) was the determinant of IMA levels in the SZ, and white blood cell count was the determinant of IMA levels in the BD group. Although the IMA levels were higher in all patient groups, the statistical significance appeared only in the BD group. Elevated IMA level was due to elevated OS in the SZ group, whereas the immunity in the BD group.

Information processing abnormalities in schizophrenia and bipolar disorder

Information processing abnormalities in schizophrenia and bipolar disorder Objective: Patients with bipolar disorder and schizophrenia exhibit abnormalities in attention, memory, working memory, verbal/visual learning and executive functions. However, many of the tests fail to detect slight changes in cognitive performance due to ceiling effect. It was aimed to determine sensitivity and specificity of the tests that measure information processing in schizophrenia and bipolar disorder in this study. Method: Thirty four patients with schizophrenia, 35 patients with bipolar disorder according to DSM-IV and 33 healthy control subjects matched for age, education level and gender were enrolled to the study. For clinical assessments Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale, Young Mania Rating Scale, Clinical Global Impression Scale and Abnormal Involuntary Movements Scale were used. All participants performed a battery consisting of tests measuring information processing including Adult Memory and Information Processing Battery (AMIPB), Trail Making Test (TMT) Form A and B, Digit Symbol Coding Task (DST) and Auditory and Visual Reaction Time Tests (RTT). Results: The schizophrenia group had significantly lower performance than the healthy control group in all tests and lower performance than the bipolar disorder group in AMIPBA and B tests, TMT A and B tests. The bipolar disorder group had lower performance than the healthy control group only in DST test. The AMIPB A and B tests were the most sensitive and specific tests in the ROC analysis. Conclusion: Changes in cognitive function might be better monitored by the tests whose sensitivity and specificity are higher. Since psychiatric disorders are highly heterogeneous, measurement tools are important for precise measurements.

Misophonia: a disorder for social world

Dear Editor, Chewing, coughing, breathing, typing are activities that produce low level sounds and these audible activities are frequently encountered in the society. These background sounds are usually ignored in public places or at home. Some people may not ignore and perceive these sounds and become disgusted. Reasons of disgust are distraction and anger. Tension might be followed by anger which may then generate urge to leave the environment or intercept the background noise. Sensitivity to the group of background noise is called misophonia. 1-3 The term consists of two words: misos (strong hate or disgust) and phonia (sound) and was introduced by Margaret and Pavel Jastreboff in 2001. 4 It was aimed to present and discuss two cases of misophonia in this letter to the editor. The first case was a young man with generalized anxiety disorder. He was also suffering from misophonia and misophonia triggered anger. He reported that particularly his family life was devastated because of his anger. The second patient was suffering from obsessive compulsive disorder and misophonia. She reported that she was counting to ten, breathing slowly or leaving the environment as soon as possible, if she cannot relax. She was frequently listening music with headphones in public places to avoid from disgusting sounds. Both patients reported that they could not express themselves during their disgust, because of inhibiting themselves due to the fear of being called crazy. Misophonia is defined as immediate negative psychological responses to certain sounds that most people do not notice. 1-3 This novel psychopathology is proposed to be involved with dysregulation of emotional processing with a neurobiological basis. 5 Current classification systems have not defined misophonia yet and it is not clear whether it is a distinct entity or a dimension or symptom domain which accompany other disorders. 3 Post-traumatic stress disorder was the most frequently accompanying disorder in a recent large-scale study. 6 Accordingly, other psychopathologies may trigger or enhance the responses and therefore misophonia might be a dimensional concept. Misophonia may deteriorate quality of life and social functioning and thus should be further investigated. 1-3,5 A Google search with the key words “misophonia treatment” retrieved 217 results in the date of January 12th. 8 of the web pages’ name was including the term “misophonia”. Increased awareness of this problem would be useful in order to develop better treatments. 7,8