Okan Caliyurt

Increased serum tumor necrosis factor-alpha levels and treatment response in major depressive disorder.

RationaleOver the last 15 years, an increasing body of evidence has suggested a causal relationship between depression and the immunological activation and hypersecretion of pro-inflammatory cytokines, such as interleukin-1, interleukin-6 and tumor necrosis factor-alpha (TNF-α). However, little is known about the probable relationship of serum TNF-α with major depressive disorder (MDD).ObjectiveTo assess whether serum TNF-α levels could be associated with the clinical course of MDD.Subjects and methodsTNF-α and C-reactive protein (CRP) serum concentrations, erythrocyte sedimentation rate, and leukocyte count were measured in 26 MDD patients and in 17 controls. The measurements were repeated following 6 weeks of antidepressant treatment with selective serotonin re-uptake inhibitors. Psychopathological improvement and the severity of depression were evaluated with the Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI).ResultsOn admission, serum TNF-α and leukocyte count were significantly higher in MDD patients compared to controls (P<0.001 and P=0.005, respectively). With the antidepressant treatment, both HAMD and BDI scores decreased significantly (P<0.001 for both). Comparison of pre- and post-treatment measurements revealed that TNF-α, CRP, and leukocyte count decreased to levels comparable with those of the control subjects (P<0.001, P=0.01, and P=0.01, respectively).ConclusionsThe results emphasized that some immunological parameters, such as CRP, leukocyte count and TNF-α, are significantly involved in the clinical course and treatment response in MDD. TNF-α in particular could be considered as a potential state marker in MDD.

Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression

Recent reports have suggested that brain-derived neurotrophic factor (BDNF) levels are reduced in individuals suffering major depressive disorder and these levels normalize following antidepressant treatment. Various antidepressants and electroconvulsive therapy are shown to have a positive effect on brain-derived neurotrophic factor levels in depressive patients. The aim of this study was to assess the effect of total sleep deprivation therapy on BDNF levels in major depressive patients. Patients were assigned to two treatment groups which consisted of 22 patients in the sertraline group and 19 patients in the total sleep deprivation plus sertraline group. Patients in the sleep deprivation group were treated with three total sleep deprivations in the first week of their treatment and received sertraline. Patients in sertraline group received only sertraline. BDNF levels were measured in the two treatment groups at baseline, 7th, 14th, and 42nd days. Patients were also evaluated using the Hamilton Rating Scale for Depression (HAM-D). A control group, consisting of 33 healthy volunteers had total sleep deprivation, BDNF levels and depression measured at baseline and after the total sleep deprivation. Results showed that serum BDNF levels were significantly lower at baseline in both treatment groups compared to controls. Decreased levels of BDNF were also negatively correlated with HAM-D scores. First single sleep deprivation and a series of three sleep deprivations accelerated the treatment response that significantly decreased HAM-D scores and increased BDNF levels. Total sleep deprivation and sertraline therapy is introduced to correlate with the rapid treatment response and BDNF changes in this study.

Role of Chronobiology as a Transdisciplinary Field of Research: Its Applications in Treating Mood Disorders

Chronobiology is a field that studies the effects of time on biological systems. Periodicity is of particular interest. The master biological clock in the suprachiasmatic nucleus controls daily rhythms of core body temperature, rest-activity cycle, physiological and behavioral functions, psychomotor functions and mood in humans. The clock genes are involved in the generation of the circadian rhythms and the biological clock is synchronized to solar day by direct photic inputs. Various circadian rhythm abnormalities have been demonstrated in mood disorders such as unipolar depression, bipolar depression and seasonal affective disorder. Hypotheses involving circadian rhythm abnormalities related to the etiology of mood disorders have been raised. The resulting circadian rhythm changes can be measured and evaluated that these techniques can be used to identify subtypes of mood disorders associated with circadian rhythm changes. The data obtained from chronobiological studies reveal methods that manipulate circadian rhythms. The effects of light and melatonin on circadian rhythms are determined by these studies. Chronobiological research has been applied to the psychiatric clinic and light therapy has been used as a chronotherapeutic in the treatment of mood disorders. On the other hand, chronotherapeutic approaches with effects on circadian rhythms such as sleep deprivation therapy have been used in the treatment of mood disorders too. As a good example of translational psychiatry, chronobiological studies have been projected in the psychiatry clinic. It may be possible, the data obtained from the basic sciences are used in the diagnosis of mood disorders and in the treatment of psychiatric disorders as chronotherapeutic techniques. Developments in the field of chronobiology and data obtained from chronotherapeutics may enable the development of evidence-based diagnosis and treatment in psychiatry.

Brain metabolism changes with 18F-fluorodeoxy- glucose-positron emission tomography in a patient with Cotard’s syndrome

Cotard’s syndrome is a rare neuropsychiatric condition which is characterized by nihilistic delusions. There are several neuroimaging studies showing different kinds of brain abnormalities in Cotard’s syndrome. However, 18F-fluorodeoxyglucosepositron emission tomography (18FFDG PET) scanning has rarely been performed in patients with Cotard’s syndrome (Charland-Verville et al., 2013). Here, we present the first case report of a patient with Cotard’s syndrome in whom hypermetabolism in the basal ganglia has been identified. A 48-year-old man with schizophrenia was brought to the emergency department by his sister for aggression and thoughts of being dead. Laboratory work-up was normal, and computed tomography (CT) scan showed mild frontal lobe atrophy. He was being prescribed amisulpride 800 mg/day and sertraline 100 mg/day. Neurologic examination revealed cogwheel rigidity in his upper extremities. Because of extrapyramidal system side effects, amisulpride was gradually withdrawn and quetiapine 600 mg/day was started and then increased up to 900 mg/day. Lorazepam 2 mg/day was added to his medication, but no clinical improvement was observed. After 3 weeks of treatment, he was still agitated and his delusions remained. In order to exclude an organic cause, an electroencephalography examination was performed and the findings were Letter

Effects of Psychiatric Disorders on Women in Sustainable Business

There are many different cultural and social roles and behaviours developed between men and women. Beyond those differences, individual’s health was also affected by sex. There are certain biological differences between men and women. Those biological, hormonal and genetic factors have great impact on gender-specific health issues. Finally, many diseases and health problems occur with different rates by gender in the population. On the other hand, some other factors like occupational health risks generated with division of labour by gender and social norms that preventing women access to health care are also very important factors that negatively affect women’s health.

Ethical Evaluation of the Duty to Report Patients Crimes in Turkish Psychiatric Practice

Psychiatry is the branch of medicine focusing on the mental disorders. Psychiatry deals with the etiology, diagnosis, treatment, rehabilitation or prevention of mental, emotional and behavioral disorders. Psychiatrists are medical doctors who graduate from medical school and take residency training in psychiatry. Ethical problems can arise in many areas of psychiatry, for example, involuntary treatment of psychiatric patients, confidentiality, informing patients about their diagnosis, or psychiatric studies. Besides these, ethical issues take place in forensic psychiatric cases and treatment interventions with pharmacotherapies or psychotherapies (Arboleda-Florez 2006).

Effects of Selective Serotonin Reuptake Inhibitors on Macular Ganglion Cell Complex Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness

ABSTRACT Purpose: To evaluate macular ganglion cell complex (GCC) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in patients treated with SSRIs. Methods: The present study included 62 eyes of 31 patients who were using SSRIs and 60 eyes of 30 healthy, age- and gender-matched control subjects. All patients underwent a full ophthalmological examination in which macular thickness, GCC thickness, and peripapillary RNFL thickness were measured using optical coherence tomography (OCT). The Mann–Whitney U test was used to compare the patients’ group with the age- and gender-matched control group. Pearson correlation analyses were also performed to assess the relationships between macular thickness, GCC thickness, RNFL thickness, and the duration of SSRI usage. Results: The mean duration of SSRI usage was 29.96 ± 27.19 (range 6–120) months. The foveal thickness was 253.48 ± 22.77µm in the patients’ group and 266.60 ± 20.64 µm in the control group; the difference between the groups was statistically significant. In addition, the perifoveal GCC thickness in the inferonasal and inferotemporal quadrant were significantly smaller thinner in the patient group (Mann–Whitney U test, p = 0.021and p = 0.013, respectively). Conclusions: Our results suggest a relation between SSRIs and decreased retinal GCC thickness and RNFL thickness. Future long-term prospective studies should elucidate the actual effect of SSRIs on GCC and RNFL thickness.

Proinflammatory cytokine levels in patients with conversion disorder.

Objective It was aimed to evaluate the relationship between proinflammatory cytokine levels and conversion disorder both commonly known as stress regulated. Method Baseline proinflammatory cytokine levels–[Tumour necrosis factor alpha (TNF‐α), Interleukin‐1 beta (IL‐1β), Interleukin‐6 (IL‐6)]–were evaluated with enzyme‐linked immunosorbent assay in 35 conversion disorder patients and 30 healthy controls. Possible changes in proinflammatory cytokine levels were evaluated again, after their acute phase in conversion disorder patients. Results Statistically significant decreased serum TNF‐α levels were obtained in acute phase of conversion disorder. Those levels increased after acute conversion phase. There were no statistically significant difference observed between groups in serum IL‐1β and (IL‐6) levels. Conclusions Stress associated with conversion disorder may suppress immune function in acute conversion phase and may have diagnostic and therapeutic value.

Aortic aneurysm and electroconvulsive therapy in elderly depressive patient.

We report the case of a 67-year-old single man with aortic aneurysm whose depression was successfully treated with electroconvulsive therapy. Metoprolol succinate was used for blood pressure control, and there were no cardiovascular side effects and no significant increase in blood pressure detected.