Nesrin Dilbaz

Oxidative mechanisms in schizophrenia and their relationship with illness subtype and symptom profile

Aim:  The aim of the present study was to investigate the differences in the antioxidant–oxidant balance (AO‐OB) between schizophrenic patients and healthy individuals and to explore the relationship of AO‐OB with illness subtypes and symptom profiles.

Metabolic syndrome in drug-naïve and drug-free patients with schizophrenia and in their siblings

OBJECTIVES We tested the hypothesis that metabolic disturbances in people with schizophrenia exist as a part of the schizophrenic syndrome, even when the antipsychotic drug effect is eliminated. We aimed to determine the prevalence of metabolic syndrome among patients with schizophrenia who were antipsychotic drug-naive or drug-free and their siblings for comparison with healthy controls. METHODS One-hundred-two patients with schizophrenia (drug-naïve or drug-free), 64 siblings and 70 age-matched healthy subjects were recruited for this case-control study. Metabolic syndrome was assessed based on Adult Treatment Panel (ATP) III, adapted ATP III and International Diabetes Federation criteria. Students t-tests, chi-squared tests, Kruskal-Wallis tests and Bonferroni corrections were used as appropriate. RESULTS The diagnoses of metabolic syndrome and metabolic disturbances as a subsyndromal state were found to be significantly more frequent in patients and their siblings than in the controls. Low levels of high-density lipoprotein cholesterol and disturbances in blood pressure put the patient group at risk for metabolic syndrome even before they were exposed to antipsychotic drugs. CONCLUSIONS Although antipsychotic drugs have consistently been related to disturbances of glucose and lipid metabolism in patients with schizophrenia, this study showed that patients with schizophrenia and their siblings are already at a high risk for metabolic syndrome independent of any antipsychotic effects. These individuals should be monitored regularly following a diagnosis of schizophrenia.

Smartphone addiction and its relationship with social anxiety and loneliness

ABSTRACT Individuals with psychosocial problems such as social phobia or feelings of loneliness might be vulnerable to excessive use of cyber-technological devices, such as smartphones. We aimed to determine the relationship of smartphone addiction with social phobia and loneliness in a sample of university students in Istanbul, Turkey. Three hundred and sixty-seven students who owned smartphones were given the Smartphone Addiction Scale (SAS), UCLA Loneliness Scale (UCLA-LS), and Brief Social Phobia Scale (BSPS). A significant difference was found in the mean SAS scores (p < .001) between users who declared that their main purpose for smartphone use was to access social networking sites. The BSPS scores showed positive correlations with all six subscales and with the total SAS scores. The total UCLA-LS scores were positively correlated with daily life disturbance, positive anticipation, cyber-oriented relationship, and total scores on the SAS. In regression analyses, total BSPS scores were significant predictors for SAS total scores (β = 0.313, t = 5.992, p < .001). In addition, BSPS scores were significant predictors for all six SAS subscales, whereas UCLA-LS scores were significant predictors for only cyber-oriented relationship subscale scores on the SAS (β = 0.130, t = 2.416, p < .05). The results of this study indicate that social phobia was associated with the risk for smartphone addiction in young people. Younger individuals who primarily use their smartphones to access social networking sites also have an excessive pattern of smartphone use.

Relationship Between Craving and Ghrelin, Adiponectin, and Resistin Levels in Patients with Alcoholism

BACKGROUND Alcoholism is a leading cause of mortality and morbidity. The most widely accepted hypothesis of its etiology is multidimensional and includes biological, psychological, and sociological factors. The biological factors have been the focus of investigation. In recent years, pathways related to nutrition and the relationship between alcohol addiction and craving have been studied. Our aim was to explore the relationship between the appetite hormones (adiponectin, ghrelin, and resistin) and alcohol craving. METHODS Blood samples were obtained from 107 male patients over a 7-day period. Levels of adiponectin, resistin, and ghrelin, the Obsessive Compulsive Drinking Scale (OCDS) score, and the Penn Alcohol Craving Scale (PACS) score were assessed on days 0 and 7. Adiponectin, resistin, and ghrelin levels were also tested in 83 healthy males in the control group. RESULTS The sample group consisted of 190 males (107 patients and 83 healthy controls). Comparison of alcohol craving scales with biological markers in the patient group showed a positive correlation between adiponectin levels and the OCDS compulsive subscale scores, and a positive correlation between ghrelin levels and the OCDS total and compulsive subscale scores and the PACS resistance subscale scores. Resistin levels were negatively correlated with the OCDS total, obsessive subscale, and compulsive subscale scores. CONCLUSIONS Although we did not observe a significant relationship between craving and any of the 3 biomarkers on day 0, craving was positively correlated with the levels of adiponectin and ghrelin and negatively correlated resistin levels on day 7. Our findings support the hypothesis that appetite hormones are trait markers for alcohol craving. Nevertheless, more conclusive results require future studies that evaluate the relationship between these hormones and withdrawal/detoxification period or long-term soberness.

Oxidative stress enzyme status and frequency of micronuclei in heroin addicts in Turkey.

Abstract Heroin is among the most widely used and dangerous addictive opiate. The World Health Organization (WHO) estimated that more than 15 million people are under the influence of opiate addiction. The aim of this study was to investigate copper zinc-superoxide dismutase (Cu,Zn-SOD), catalase (CAT) and selenium-dependent glutathione peroxidase (Se-GPx) antioxidant enzyme activities, malondialdehyde (MDA) levels and the frequency of micronuclei (MN) in addicts using heroin, the most commonly abused opiate in Turkey. Addicts were defined as individuals diagnosed according to “Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)” criteria by the “Alcohol and Substance Abuse Treatment and Education Centre-Ankara (AMATEM)”. The control group had no addiction. In comparisons between the groups, a significant decrease in Cu,Zn-SOD activity and increases in MDA levels and MN frequency were observed in addicts. It can be concluded that opiates may cause oxidative stress and that antioxidant supplementation, in addition to pharmacological and psychiatric approaches, can reduce the toxicological effects of these opiates.

Thalamic and Cerebellar Gray Matter Volume Reduction in Synthetic Cannabinoids Users

Background: Synthetic cannabinoids are compounds that bind cannabinoid receptors with a high potency and have been used widely in Europe by young people. However, little is known about the pharmacology and morphological effects of this group of substances in the brain. This study is aimed at investigating the morphological differences among synthetic cannabinoids users and healthy controls. Methods: Voxel-based morphometry was used to investigate the differences in brain tissue composition in 20 patients with synthetic cannabinoids use and 20 healthy controls. All participants were male. Results: Compared to healthy controls, voxel of interest analyses showed that regional grey matter volume in both left and right thalamus and left cerebellum was significantly reduced in synthetic cannabinoids users (p < 0.05). No correlation has been found between the age of first cannabis use, duration of use, frequency of use and grey matter volume. Discussion: These preliminary results suggest an evidence of some structural differences in the brain of synthetic cannabinoids users, and point the need for further investigation of morphological effects of synthetic cannabinoids in the brain.

Cyclopentolate hydrochloride eye drops addiction: a case report.

Cyclopentolate, a synthetic anticholinergic, has been widely used as a cycloplegic and mydriatic agent for more than 40 years. Abuse of anticholinergic drugs for their stimulating and euphoriant effects has been known for a long time (Pullen, 1984). Anticholinergic drug abuse is observed not only in psychiatric patients but also in individuals without psychiatric comorbidities. It is well known that anticholinergic drugs can be abused with alcohol and other drugs (Pullen, 1984; Crouch et al., 2004). In this report, a case of anticholinergic addiction due to anticholinergic eye drops, a physiological dependence on cyclopentolate hydrochloride, is reported.

Volumetric brain abnormalities in polysubstance use disorder patients.

Aim Polysubstance users represent the largest group of patients seeking treatment at addiction and rehabilitation clinics in Turkey. There is little knowledge about the structural brain abnormalities seen in polysubstance users. This study was conducted to examine the structural brain differences between polysubstance use disorder patients and healthy control subjects using voxel-based morphometry. Methods Forty-six male polysubstance use disorder patients in the early abstinence period and 30 healthy male controls underwent structural magnetic resonance imaging scans. Voxel-based morphometry analysis was performed to examine gray matter (GM) abnormality differences. Results Polysubstance use disorder patients displayed significantly smaller GM volume in the thalamus, temporal pole, superior frontal gyrus, cerebellum, gyrus rectus, occipital lobe, anterior cingulate cortex, superior temporal gyrus, and postcentral gyrus. Conclusion A widespread and smaller GM volume has been found at different regions of the frontal, temporal, occipital, and parietal lobes, cerebellum, and anterior cingulate cortex in polysubstance users.

Association between ADH1C and ALDH2 polymorphisms and alcoholism in a Turkish sample.

Abstract Background: Polymorphisms in the genes encoding alcohol metabolizing enzymes are associated with alcohol dependence. Aim: To evaluate the association between the alcohol dehydrogenase 1C (ADH1C) Ile350Val and aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphisms and alcohol dependence in a Turkish sample. Methods: 235 individuals (115 alcohol-dependent patients and 120 controls) were genotyped for ADH1C and ALDH2 with PCR–RFLP (polymerase chain reaction–restriction fragment length polymorphism). Association between the polymorphisms and family history, daily and maximum amount of alcohol consumed was investigated. The associations between alcohol dependence, severity of consumption and family history and the polymorphisms were analyzed by chi-square or Fishers exact test where necessary. Relationship between genotypes and dependence related features was evaluated using analysis of variance (ANOVA). Results: The -350Val allele for ADH1C (ADH1C*2) was increased in alcohol-dependent patients (P = 0.05). In individuals with a positive family history, the genotype distribution differed significantly (P = 0.031) and more patients carried the Val allele compared with controls (P = 0.025). Genotyping of 162 participants did not reveal the -504Lys allele in ALDH2. Conclusions: These findings suggest that ADH1C*2 is associated with alcohol dependence in the Turkish population displaying a dominant inheritance model. ADH1C*2 allele may contribute to the variance in heritability of alcohol dependence. The ALDH2 -504Lys/Lys or Glu/Lys genotypes were not present in alcohol-dependent patients, similar to that seen in European populations and in contrast to the findings in the Asian populations.

Treatment Resistant Generalized Anxiety Disorder

1.1 Epidemiology of social anxiety disorder (SAD) SAD, also known as social phobia, is characterised by excessive fear of embarrassment or humiliation in social situations, which in turn leads to marked distress or avoidance of these situations and functional impairment as described in DSM-IV-TR. It is a common disorder with early onset, significant comorbidity and functional impairment (Meron Ruscia et al., 2008). SAD has been ranked as one of the top ten chronic disorders – mental or physical – in terms of its effects on objective outcomes, such as days of work lost and reduced health-related quality of life (Alonso, 2004). According to the National Comorbidity Survey, SAD is the most reported anxiety disorder and has a lifetime prevalence of 12% (Kessler et al., 2005), with considerable coexisting psychiatric disorders, such as depression, anxiety, and substance-related disorders.Lifetime prevalence of social anxiety disorder among Turkish university students was 23% (Dilbaz 2006). Co-occurring SAD and depression carry a substantial risk of suicide, which further complicates treatment (Beesdo et al., 2007; Thase, 2007). SAD symptoms normally emerge during early adolescence and continue throughout adulthood; they affect women more often than men (Fehm et al., 2005).In clinical samples the ratio of male and female changes in the favour of males. (Dilbaz and Güz 2002). Trials suggest that social anxiety even below the diagnostic threshold is clearly associated with adverse outcomes like elevated risk for comorbid disorders and associated with impairment in diverse areas of life. Despite the growing understanding of this condition, information is lacking on key aspects of the disorder and many individuals, including doctors, psychiatrists and patients, unaware about this condition.1.1 Epidemiology of social anxiety disorder (SAD) SAD, also known as social phobia, is characterised by excessive fear of embarrassment or humiliation in social situations, which in turn leads to marked distress or avoidance of these situations and functional impairment as described in DSM-IV-TR. It is a common disorder with early onset, significant comorbidity and functional impairment (Meron Ruscia et al., 2008). SAD has been ranked as one of the top ten chronic disorders – mental or physical – in terms of its effects on objective outcomes, such as days of work lost and reduced health-related quality of life (Alonso, 2004). According to the National Comorbidity Survey, SAD is the most reported anxiety disorder and has a lifetime prevalence of 12% (Kessler et al., 2005), with considerable coexisting psychiatric disorders, such as depression, anxiety, and substance-related disorders.Lifetime prevalence of social anxiety disorder among Turkish university students was 23% (Dilbaz 2006). Co-occurring SAD and depression carry a substantial risk of suicide, which further complicates treatment (Beesdo et al., 2007; Thase, 2007). SAD symptoms normally emerge during early adolescence and continue throughout adulthood; they affect women more often than men (Fehm et al., 2005).In clinical samples the ratio of male and female changes in the favour of males. (Dilbaz and Guz 2002). Trials suggest that social anxiety even below the diagnostic threshold is clearly associated with adverse outcomes like elevated risk for comorbid disorders and associated with impairment in diverse areas of life. Despite the growing understanding of this condition, information is lacking on key aspects of the disorder and many individuals, including doctors, psychiatrists and patients, unaware about this condition.