Omer Yanartas

Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors.

Objective Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. Methods The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. Results Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. Conclusion Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression.

The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease

Objective Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. Patients and methods Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. Results Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn’s disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. Conclusion In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn’s disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

Neuroprotective effect of ebselen against intracerebroventricular streptozotocin-induced neuronal apoptosis and oxidative stress in rats

The goal of this study was to examine the neuroprotective effect of ebselen against intracerebroventricular streptozotocin (ICV-STZ)-induced oxidative stress and neuronal apoptosis in rat brain. A total of 30 adult male Sprague-Dawley rats were randomly divided into 3 groups of 10 animals each: control, ICV-STZ, and ICV-STZ treated with ebselen. The ICV-STZ group rats were injected bilaterally with ICV-STZ (3 mg/kg) on days 1 and 3, and ebselen (10 mg/kg/day) was administered for 14 days starting from 1st day of ICV-STZ injection to day 14. Rats were killed at the end of the study and brain tissues were removed for biochemical and histopathological investigation. Our results demonstrated, for the first time, the neuroprotective effect of ebselen on Alzheimer’s disease (AD) model in rats. Our present study, in ICV-STZ group, showed significant increase in tissue malondialdehyde levels and significant decrease in enzymatic antioxidants superoxide dismutase and glutathione peroxidase in the frontal cortex tissue. The histopathological studies in the brain of rats also supported that ebselen markedly reduced the ICV-STZ-induced histopathological changes and well preserved the normal histological architecture of the frontal cortex tissue. The number of apoptotic neurons was increased in frontal cortex tissue after ICV-STZ administration. Treatment of ebselen markedly reduced the number of degenerating apoptotic neurons. The study demonstrates the effectiveness of ebselen, as a powerful antioxidant, in preventing the oxidative damage and morphological changes caused by ICV-STZ in rats. Thus, ebselen may have a therapeutic value for the treatment of AD.

The relationship between psychopathology and cognitive functions with cytokines in clinically stable patients with schizophrenia

ABSTRACT OBJECTIVES Inflammation and the cytokine hypotheses have been proposed for schizophrenia. Several proinflammatory and anti-inflammatory cytokines have been studied in drug-naive, first-episode, and/or chronic schizophrenia patients. However, there were limited data on clinical stable outpatients reflecting daily routine. The aim of this study was to compare the serum levels of cytokines, including transforming growth factor-beta (TGF-β), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), between clinically stable patients with schizophrenia and healthy controls, as well as to examine the relationship between these inflammation parameters and clinical variables (positive and negative symptom severity and cognitive functions). METHODS Thirty clinically stable outpatients with schizophrenia and 30 healthy controls with similar sex and age were included in this study. Serum IL-6, TGF-β, and TNF-α levels were assessed by enzyme-linked immunosorbent assay (ELISA) and immunoenzyme microplate measurement, respectively. Illness severity was evaluated using the Positive and Negative Syndrome Scale (PANSS), and the cognitive functions of the participants were assessed using a broad neuropsychological test battery. RESULTS The serum levels of IL-6 and TGF-β were significantly higher in patients with schizophrenia compared to healthy controls (p = .048, p = .012). There was no significant difference between groups in terms of TNF-α levels (p = .726). Global impairment of cognitive functions was observed in the patient group compared to healthy controls, and PANSS scores and cognitive functions showed no correlation with cytokine levels (IL-6, TNF-α, and TGF-β). CONCLUSIONS The present study demonstrated an increased inflammatory response in clinically stable patients with schizophrenia compared to healthy controls. However, symptom severity and cognitive functions showed no correlation with cytokine levels. Further research studies are needed to clarify the effects of cytokine levels on schizophrenia symptomatology and etiopathogenesis.

Evaluation of depression, anxiety, alexithymia, attachment, social support and somatization in functional dyspepsia

ABSTRACT AIM: The psychiatric and psychosocial aetiology of Functional dyspepsia is not well known. In the present study, our aim is to determine the relative contributions of psychiatric predictors – i.e. depression, anxiety, somatization, alexithymia – in relation with socio-psychological factors, specifically their personal characteristics (i.e. emotional attachment) and perceived social support, in distinguishing FD from organic dyspepsia and healthy samples. MATERIAL AND METHODS: An estimated 30 functional dyspepsia, 29 organic dyspepsia patients who were admitted to our gastroenterology outpatient clinic and 27 healthy controls were enrolled to our study. Beck Depression Inventory, Toronto Alexithymia Scale, Adult Attachment Scale, State-Trait Anxiety Inventory, Multidimensional Scale of Perceived Social Support and somatization sub-scale of Symptom Checklist-90 were provided to all patients and healthy controls. All participants were examined by a gastroenterologist and a psychiatrist. RESULTS: Healthy controls were younger than organic dyspepsia group and women/men rate was lower in organic dyspepsia than other two groups. Depression score was higher in functional dyspepsia group than in healthy controls and functional dyspepsia group’s attachment syle was more secure than that of the healthy control group. Somatization rate was seen higher in functional dyspepsia group with psychiatric examination. There was no significant difference seen in anxiety, alexithymia and social support between the three groups. DISCUSSION: Anxious-avoidant attachment profile as well as the higher propensity to have depressive and anxiety symptoms might be critical psychiatric and psychosocial factors underlying FD’s aetiology. A multidisciplinary approach is needed in the follow up of functional dyspepsia patients. Psychological evaluation and treatment would increase the life quality of dyspepsia patients.

Depression, anxiety, alexithymia and somatosensory sensitivity in patients with benign palpitation

ABSTRACT Objective: The aim of this study is to compare the frequency of depression, anxiety, alexithymia and somatosensory sensitivity in patients with benign palpitation with healthy controls. Method: Sixty-one patients with palpitation and 59 age- and sex-matched control subjects were enrolled. All study subjects were undergone thorough cardiac evaluation, and patients with palpitation also had echocardiography and 24-hour ECG monitoring to rule out significant arrhythmias, coronary artery disease and structural heart disease. All subjects were assessed by Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia scale, Whiteley Index (WI) and Somatosensory Amplification Scale (SAS). Results: Patients with benign palpitation had significantly increased BAI, BDI, WI and SAS scores. Anxiety is the only independent predictor of benign palpitation (odds ratio = 1.12, 95% confidence interval = 1.05–1.19, p < 0.001). Conclusion: This study shows that patients with benign palpitation had increased anxiety levels and somatization disorders. So an integrated psycho-cardiological approach is needed in this special population.

Treatment Resistant Depression and Sleep Apnea: A Case Report

Treatment resistance is an important issue in patients with depressive disorder and nearly a third of patients may not reach remission despite multiple drug trials. Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder in which daytime sleepiness, sleep disturbance, fatigue, decreased quality of life, memory problems, irritability are frequently observed. Polysomnography is required to confirm the diagnosis of OSAS We aim to present a case with treatment resistant depressive symptoms. In his detailed assessment we observed that his complaints were related to OSAS and he was successfully treated with bi-level positive airway pressure (BPAP). Particular attention shoul be paid to OSAS symptoms in patients with treatment resistant depression.

P137 Sexual dysfunction in inflammatory bowel disease patients

whose SES-CD was 3 whereas it was 88% in patients whose SES-CD was 2 (p < 0.01). This tendency was observed both in patients who were treated with/without biologics. Cox regression analysis after adjustment of possible confounding factors revealed that SES-CD 2 was found to be independent determinants of non-relapse (HR 0.17; 95%CI 0.06 0.48). Conclusions: The present study demonstrated that endoscopic remission (SES-CD 2) predicted long-term prognosis even in patients with clinical remission.

An outpatient clinical study of dissociative disorder not otherwise specified

The relatively high prevalence of the diagnosis of dissociative disorder not otherwise specified is frequently considered to be disproportionate. The disproportionate rate of this diagnosis is thought to be related to nosologic and/or diagnostic issues in dissociative identity disorder. We sought to investigate and compare the symptom patterns of these two clinical entities. We conducted a cross-sectional study involving 1314 participants who were screened with the Dissociative Experience Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). Of the participants, 272 who scored above the cut-off points for the screening questionnaires (DES score>30 and/or SDQ score>40 points) were invited to complete a structured interview using the Dissociative Disorders Interview Schedule (DDIS); of this subsample, only 190 participants agreed to participate in the second phase of the study. The mean score for the DES was 18.55±17.23, and the mean score for the SDQ was 30.19±13.32. Of the 190 participants, 167 patients were diagnosed as having a dissociative disorder (87.8%). We found that DD-NOS was the most prevalent category of dissociative disorder. There was a significantly larger percentage of patients in the DID group than in the DD-NOS group according to secondary features of DID and Schneiderian symptoms. The secondary features of DID and Schneiderian symptoms appeared to be more specific for DID, while no differences were detected between DID and DD-NOS based on most of the items on the SCL 90R. Further longitudinal studies are needed to determine the features that are similar and dissimilar between DD-NOS and DID.

Metilfenidat ekleme tedavisi sırasında gelişen manik hecme

Methyphenidate is used in treating patients with depression, narcolepsy, traumatic brain injury, cancer pains and HIV related cognitive impairment as well as treatment of Attention Deficit Hyperacivity Disorder(ADHD) in adults and children. It is known that usage of psychostimulants in high dosages may exacerbate manic and psychotic symptoms. This is a case presenting with manic symptoms after long acting methylphenidate is added to venlafaxine treatment for depression. 25 year old male, brought with complaints of increased religious activity, saying God is making him do things, increase of appetite, being talkative, greeting cemetaries and decreased sleep. In psychiatric assessment, his psychomotor activity was high, speech was pressured, had auditory hallucinations; had delusions of referance, grandieur and control, had no insight. He had been on venlafaxine treatment for depression for the last three months, 225mg/day for the last two. Methylphenidate 36mg/day was added to treatment 2 months before. His presenting symptoms started after it was increased to 54mg/day. Our diagnosis was manic episode (with psychotic features). One of the potential adverse effects of methylphenidate is exacerbation of manic symptoms. ADHD and Bipolar Disorder comorbidity may reach to 40%. However, our case did not have a comorbid ADHD. We associated manic symptoms with use of methylphenidate since the sypmtoms have started at the fourth month of venlafaxine treatment and after the increase of dosages of methylphenidate dosage.