Numan Konuk

The comorbidity of adult attention-deficit/hyperactivity disorder in bipolar disorder patients.

OBJECTIVE High comorbidity ratio of bipolar mood disorder (BMD) with Axis I and Axis II diagnoses is reported in the literature. The possible relationship between BMD and attention-deficit/hyperactivity disorder (ADHD) in all age groups has been attracting more attention of researchers due to highly overlapping symptoms such as excessive talking, attention deficit, and increased motor activity. In this study, we aimed to investigate the prevalence of ADHD comorbidity in BMD patients and the clinical features of these patients. METHODS Of 142 patients, who presented to the Bipolar Disorder Unit of Zonguldak Karaelmas University Research and Application Hospital between the dates of August 1, 2008 and June 31, 2009 and diagnosed with BMD according to DSM-IV criteria consecutively, 118 patients signed informed consent and 90 of them completed the study. They all were in euthymic phase during the study evaluations. A sociodemographical data form, Wender-Utah Rating Scale (WURS), ADD/ADHD Diagnostic and Evaluation Inventory for Adults, and Structural Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-I) were applied to all participating patients. RESULTS A total of 23.3% of all patients met the criteria for A-ADHD diagnosis along BMD. No difference was detected regarding sociodemographical features between the BMD+A-ADHD and the BMD without A-ADHD groups. The BMD+A-ADHD group had at least one extra educational year repetition than the other group and the difference was statistically significant. The BMD starting age in the BMD+A-ADHD group was significantly earlier (p=0.044) and the number of manic episodes was more frequent in the BMD+A-ADHD group (p=0.026) than the BMD without ADHD group. Panic disorder in the BMD+A-ADHD group (p=0.019) and obsessive-compulsive disorder in the BMD+C-ADHD group (p=0.001) were most frequent comorbidities. CONCLUSIONS A-ADHD is a frequent comorbidity in BMD. It is associated with early starting age of BMD, higher number of manic episodes during the course of BMD, and more comorbid Axis I diagnoses.

Pain perception in patients with bipolar disorder and schizophrenia

Objective: Pain perception is reported to be altered in patients with depression and schizophrenia. However, few studies have investigated the pain perception in patients with bipolar disorders. We therefore aimed to compare pain sensitivity between patients with bipolar disorder, schizophrenia and controls. Methods: Study groups consisted of 30 patients with bipolar disorder, and control groups consisted of 27 patients with schizophrenia and 59 healthy subjects. Pain perception was assessed with cold pressor test (CPT) by exposure to ice-water. Results: Patients with schizophrenia had significantly higher pain thresholds (PTh) than patients with bipolar disorder. There were no differences between the PTh of patients with schizophrenia and healthy control subjects. However, patients with bipolar disorder had significantly lower pain tolerance (PT) in the CPT than patients with schizophrenia and corresponding healthy control subjects. Conclusions: The higher PTh in the schizophrenia group compared with the bipolar group found in this study supports further investigation of a potential difference in the pain perception between patients with schizophrenia and bipolar disorder. Theoretical implications of these findings and possible relevant behavioural and neurochemical mechanisms are discussed.

Acute dystonia during pegylated interferon alpha therapy in a case with chronic hepatitis B infection

Interferon (IFN) is the most widely prescribed drug of choice for chronic hepatitis B infection, which is a common health problem in our country. Therapy with IFN-alpha may be associated with a number of neuropsychiatric symptoms, such as Parkinsonism, akathisia, seizure, and depressive disorders. In this case report, we present clinical and laboratory findings of a case with chronic hepatitis B that developed acute dystonia soon after the first dose of pegylated interferon alpha. As far as we know, this is the first report in English literature indicating such an adverse effect of pegylated interferon alpha.

Psychological status and patient-assessed health instruments in ankylosing spondylitis.

Background:Determination of the relationships between disease and psychological status in ankylosing spondylitis (AS) is needed for clinical assessment and management, as well as selection and monitoring of AS patients for biological therapy. Objective:The study aimed to describe associations between self-reported health status and psychological factors in AS patients and to compare the Symptom Checklist 90-Revised (SCL-90-R) profiles of the AS patients and the control subjects. Methods:Disease status was determined through the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and the Bath AS Metrology Index (BASMI). Psychological status was measured using the SCL-90-R. Results:BASDAI and BASFI scores correlated with somatization, anxiety, obsessive-compulsive, depression, and hostility subscales of SCL-90-R (P ≤ 0.05). BASFI scores were significantly correlated with interpersonal sensitivity and phobic anxiety subscales of SCL-90-R (P < 0.05), whereas no correlation was observed between BASDAI and interpersonal sensitivity and phobic anxiety subscales. BASMI scores were significantly correlated with somatization and interpersonal sensitivity subscales (P < 0.05). After age and sex adjustments, a statistically significant difference was determined between the somatization scores of the AS patients and control subjects (P = 0.005). Conclusion:AS is a chronic disease, which causes deformities and workforce decline. This, in turn, might lead to psychological distress. There is a need to assess the mood of patients with AS. Completion of self-report assessment tools are potentially confounded by reporting biases that result from psychological factors. Some patients may overreport symptoms or disability because of a tendency to somatize. Thus, during interpretation of these tools, psychological status should be taken into account especially deciding the treatment regimen including biologic therapies.

Food addiction and the outcome of bariatric surgery at 1-year: Prospective observational study

PURPOSES The objectives of the current study were to determine the prevalence of food addiction in bariatric surgery candidates and whether food addiction is associated with weight loss after bariatric surgery. METHODS This prospective observational study was performed on morbidly obese patients who had been found suitable for bariatric surgery. Follow-up was conducted at the 6 and 12 month post-surgery. The Yale Food Addiction Scale (YFAS) was used to determine food addiction. RESULTS One hundred seventy-eight patients were included. Pre-operative food addiction was found in 57.8% of patients. Food addiction prevalence decreased at the 6 and 12 month follow ups, to 7.2% and 13.7% respectively. There were no statistically differences between those with food addiction and those without addiction with regard to weight loss measured as percent of excess BMI at the 12 month follow-up. CONCLUSION Food addiction as measured by the YFAS decreases significantly after bariatric surgery. The presence of food addiction before surgery was not associated with weight loss as measured EBL%. However, in view of the increase in BMI, 2 years after surgery longer follow up studies are warranted.

The prevalence and clinical features of the night eating syndrome in psychiatric out-patient population

OBJECTIVE In this study we aimed to investigate the prevalance and clinical correlations of night eating syndrome (NES) in a sample of psychiatric outpatients. METHOD Four hundred thirthy three consecutive psychiatric out-patients older than 18years were evaluated in the outpatient clinics using clinical interview according to the DSM-IV with regard to psychiatric diagnosis. Participants were also screened for presence of NES utilizing both clinical interview and self report based on Night Eating Questionnaire (NEQ) instruments. Sociodemographic and clinical features such as age, gender, education level, socioeconomic level and body mass index (BMI) were also recorded. The Body Shape Questionnaire (BSQ) and the Symptom Checklist-90 Revised (SCL-90R) were administered. RESULTS Based on the proposed diagnostic criteria of the NES via utilizing clinical interview method, 97 (32 male, 65 female) of the sample met diagnostic criteria for NES. The point prevalence of NES was 22.4%. No statistically significant differences were found between the two groups in terms of age, gender, marital status, education and BMI. The patients with NES had higher NEQ, BSQ and SCL-90R subscale scores than patients without NES. Prevalance of depressive disorder, impulse control disorder, and nicotine dependency was higher among patients with NES. No differences were found with regard to the medication (antipsychotics, antidepressants and mood stabilizers). CONCLUSION Night eating syndrome is prevalent among psychiatric outpatients and associated with depression, impulse control disorder, and nicotine dependency. Body dissatisfaction and higher symptom severity are also other risk factors for the development of NES.

A Comparison of Reboxetine and Amitryptilline in the Treatment of Fibromyalgia Syndrome with Co-morbid Depressive Symptoms: An Open-label Preliminary Study

Amac: Fibromyalji (FM) yeni tedavi aray›fllar›n›n surdu¤u onemli bir halk sal›¤› sorunudur. Bu cal›flmada FM tedavi- sinde s›kl›kla kullan›lan trisiklik antidepresan amitriptilin ile henuz yeterince araflt›r›lmam›fl secici noradrenalin geri al›m inhibitoru reboksetinin etkilerinin karfl›laflt›r›lmas› amaclanm›flt›r. Ayr›ca noradrenalinin ar› duyumundaki mekanizmalarla iliflkisi bak›m›ndan, secici noradrenalin ge- ri al›m inhibitoru reboksetinin FM hastalar›nda etkinliini de deerlendirmek amaclanm›flt›r. Yontem: Depresif semptomlar› da olan 21 FM hastas› 25- 75mg/gun amitriptilin ya da 8 mg/gun reboksetine rando- mize edildi. Hastalar bafllang›c, 2,4 ve 8. haftalarda Fibrom- yalji Etki Anketi (FEA), Beck Anksiyete ve Depresyon Olcek- leri (BAI, BDI), Hamilton Anksiyete ve Depresyon Olcekleri (HAM-A, HAM-D) ile deerlendirildi. Ar› fliddeti Gorsel Analog Skala (GAS) ile deerlendirildi. Bulgular: Her iki ilac grubunda FEA ve GAS puanlar› ile sap- tanan FM belirtileri ve depresif belirtilerinde iyileflme ile iliflkili bulundu. General Lineer Model Tekrarl› Olcumler tes- ti, FEA ve GAS puanlar›nda gruplar aras› fark ya da zaman x grup etkileflimi olmaks›z›n anlaml› azalman›n bulunuduu- nu gosterdi. Her iki grupta da kayda deer ciddi yan etki gozlenmedi. Sonuc: Bu ac›k cal›flmada gerek amitriptilinin gerekse re- boksetinin FM hastalar›n›n ar› ve depresif semptomlar›n- daki iyileflme ile iliflkili olduu gosterilmifltir. Etkililik cal›fl- mas› nedensellii ve etkinlii gostermediinden kesin so- nuclar c›karsamak icin daha buyuk gruplarda plasebo kon- trollu, cift kor cal›flmalara ihtiyac vard›r. Araflt›rmam›z›n bul- gular› FM tedavisi icin yap›lacak cal›flmalara dair onemli ipuclar› sunmaktad›r. ABSTRACT:of reboxetine and amitryptilline in the treatment of fibromyalgia syndrome with co-morbid depressive symptoms: an open-label preliminary study Objective: Fibromyalgia (FM) is a chronic debilitating disorder that results in millions of dollars of heathcare costs and lost wages each year worldwide. It is a significant public health concern and new treatments are needed. In this study, we aimed to compare the effectiveness of a widely used tricyclic antidepressant for FM (amitryptylline) and one that has not yet been widely used (reboxetine) for FM in a within-subject pre-posttreatment design. Additionally, since noradrenaline (NA) is thought to play a relevant role in the antinociceptive mechanisms, we also aimed to examine the effectiveness of reboxetine as a selective NA reuptake inhibitor (NARI) in patients with fibromialgia. Methods: Twenty-one patients with fibromyalgia were randomized to receive amitiriptylline (25-75 mg/day) or reboxetine (8 mg/day). Patients were administered the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression and Anxiety Inventories (BDI, BAI), and the Hamilton Rating Scales for Depression and Anxiety (HAM- D, HAM-A) at the treatment weeks 2, 4, and 8. The intensity of the pain was recorded using a Visual Analog Scale (VAS). Results: We found both medications to be associated with improvement in pain (decreased VAS scores), FIQ scores, and depressive symptomotology. General linear model repeated measures analysis on the VAS and FIQ scores showed a significant decrease over time in both treatment groups without significant group difference or time x group interaction effect. There were no serious adverse events in both groups. Conclusions: This open trial demonstrated that either reboxetine or amitryptylline would be effective for the treatment of pain symptoms in patients with FM. Since open-label clinical effectiveness studies do not provide definitive conclusions about causality or efficacy, double blind, placebo-controlled studies in larger clinical groups are needed to reach a definitive conclusion. Our findings provide clinical researchers important information about the novel treatment options for FM.

Can Priapism Occur as an Idiosyncratic Reaction to Risperidone

Priapism can be associated with sickle cell anemia, perineal trauma, leukemia, and other neoplasms (1,2). It can also be associated with the use of systemic or intracorporeal vasoactive agents and antidepressants, antipsychotics, antihypertensives, and recreational drugs (4). Although typical antipsychotics are thought to be related to priapism, there are some case reports on the relationship between atypical antipsychotics (e.g., risperidone, clozapine, ziprasidone, quetiapine, olanzapine, and aripiprazole) and priapism 5,6,7,8,9,10). In the literature, priapism has been been associated with risperidone administered at any stage of treatment and in different doses, alone or in combination with psychotropic drugs, and with long-acting injectable risperidone (2,11,12,13,14).

The case of a 43-year old Turkish male patient with Nasu-Hakola disease.

1876-2018/

Çok yüksek doz ketiapin alımı ile intihar girişimi / Suicide attempt with a very high dose of quetiapine

– see front matter 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.08.068 (Madry et al., 2007; Chouery et al., 2008). Two gene mutations have been detected in genetic studies. The genes are DAP12 (TYRO protein tyrosine kinase-binding protein, TYROBP) and TREM2 (triggering receptor expressed on myeloid cells) genes (Nakamagoe et al., 2011; Numasawa et al., 2011). The patient was a 43 year-old male who admitted to the inpatient clinic with personality and behavioral changes, inappropriate behaviors and speech. Bone fractures started before seven years ago with right knee and ankle and continued with several extremities. Dementia was reported to be progressive and started within 4 years. The patient abused alcohol for 14 years. Patient’s sister died before the age of 50 by becoming bedridden within 4 years, due to a progressive dementia. Results of neuropsycological assessment showed a common cognitive impairment, which was characterized by visuopatial function loss and frontal lobe related symptoms, accompanied by moderate-advance verbal memory loss and advance non-verbal memory loss. Cranial brain tomography showed apparent cortical sulci and fissures and calcification in both putamen levels (Fig. 1). The MRI revealed extension of cerebral hemispheric cortical sulcus depth and lateral ventricle widths and symptoms of cerebral-cerebellar atrophy (Fig. 2). Perfusion defects at both of the parietooccipital regions which was slightly more clear at the left were seen on SPECT examination (Fig. 3). Significant reduction in trabecular structure, irregular cortical thinning and cystic areas were observed in the bilateral knee computed tomographic imaging (Fig. 4). Plain X-ray images of hands and fingers revealed multiple bone cysts (Fig. 5). In order to prevent possible physical, financial and social risks, it is important to be informed about the disease. Informing patients and their relatives about physical activities may be helpful. We suggest that, a better knowledge about the disease will give advantage to us while dealing with the problems and also for the clinical follow-up of these patients.