Osman Virit

Beneficial effects of N-acetylcysteine in treatment resistant schizophrenia

Poor response to antipsychotics is still an important problem in the treatment of many schizophrenia patients. N-Acetylcysteine (NAC) is a compound that exerts anti-oxidant and scavenging actions against reactive oxygen species. This paper reports a case of poorly responsive schizophrenia patient who improved considerably with add-on NAC 600 mg/day. The NAC might work through activating cysteine-glutamate antiporters or reducing in nitric oxide (NO) metabolites, free radicals and cytokines or through both of these mechanisms.

A Defect in the Antioxidant Defense System in Schizophrenia

Objectives: Several oxidants and antioxidants have been evaluated in schizophrenia. However, previous studies frequently focused on individual parameters. Determination of the total oxidant and antioxidant status may be more useful. Therefore, we aimed to evaluate both plasma total oxidant status (TOS) and total antioxidant status (TAS) together with the oxidative stress index (OSI) in schizophrenia patients for the first time in the literature. Methods: A total of 60 schizophrenia patients and 40 healthy volunteers were included in the study. The Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-severity scale (CGI-S) were used to evaluate the severity of schizophrenia in the patients. TOS and TAS were measured in plasma and the OSI was calculated for patients and controls. Results: There was no difference between patients and controls with regard to TOS, but the patients’ TAS and OSI were significantly lower and higher, respectively, than those of the controls. No difference was detected between the schizophrenia subtypes or between the patients on typical or atypical antipsychotic medications or a combination of the two with regard to oxidative parameters. There was a weak to moderately significant negative correlation between TAS and total, positive and general psychopathology PANSS scores. Finally, we found a weak to moderately significant negative correlation between the CGI-S score and TOS and between the CGI-S score and TAS. Conclusions: There is a defect in the antioxidant defense system in schizophrenia. Known oxidative stress that causes oxidative cell damage and thus contributes to the pathophysiology of schizophrenia may be mainly related to this defensive defect.

Alexithymic features in migraine patients

Abstract.The aims of the present study were 1) to investigate the alexithymic features in migraine patients and, 2) if alexithymia has any relation with the results of other psychological scales that are widely used in clinical practice to describe the psychopathologies, such as depression and anxiety. Demographic and clinical data of 50 cases with migraine without aura and 50 normal volunteers were supplied. All cases completed the Beck Depression Inventory, Hamilton Depression Rating Scale, State and Trait Anxiety Inventory and Toronto Alexithymia Scale. Migraine patients were significantly more depressive, anxious and alexithymic than the control group; there was no correlation between TAS scores and demographic variables; not depression but anxiety was significantly correlated with alexithymia in the migraine group, whereas none of the scores were found to be related to alexithymia in controls. According to our results, alexithymia is a frequent finding in migraine patients and is associated with anxiety to a considerable extent but not with depression.

Increased oxidative stress and oxidative DNA damage in non-remission schizophrenia patients

Increasing evidence shows that oxidative stress plays a role in the pathophysiology of schizophrenia. But there is not any study which examines the effects of oxidative stress on DNA in schizophrenia patients. Therefore we aimed to assess the oxidative stress levels and oxidative DNA damage in schizophrenia patients with and without symptomatic remission. A total of 64 schizophrenia patients (38 with symptomatic remission and 26 without symptomatic remission) and 80 healthy volunteers were included in the study. 8-hydroxydeoxyguanosine (8-OHdG), total oxidant status (TOS) and total antioxidant status (TAS) were measured in plasma. TOS, oxidative stress index (OSI) and 8-OHdG levels were significantly higher in non-remission schizophrenic (Non-R-Sch) patients than in the controls. TOS and OSI levels were significantly higher in remission schizophrenic (R-Sch) patients than in the controls. TAS level were significantly lower and TOS and OSI levels were significantly higher in R-Sch patients than in Non-R-Sch patients. Despite the ongoing oxidative stress in patients with both R-Sch and Non-R-Sch, oxidative DNA damage was higher in only Non-R-Sch patients compared to controls. It is suggested that oxidative stress can cause the disease via DNA damage, and oxidative stress plays a role in schizophrenia through oxidative DNA damage.

Improvement of restless legs syndrome and trichotillomania with aripiprazole

The case report describes a 39‐year‐old woman with restless legs syndrome (RLS) and trichotillomania (TTM). She was treated with venlafaxine and clonazepam with partial remission of RLS and no response for TTM. When aripiprazole was added to the clonazepam both RLS and TTM fully remitted. We suggest that aripiprazole might be worth investigating for treatment of these disorders.

High ceruloplasmin levels are associated with obsessive compulsive disorder: a case control study

BackgroundAlterations in ceruloplasmin are currently assumed as one of the mechanisms underlying the development of a number of neurodegenerative disorders. Several studies indicate that elevated serum ceruloplasmin levels may play a role in schizophrenia by exacerbating or perpetuating dopaminergic dysregulation. No study investigating the relationship between ceruloplasmin and obsessive-compulsive disorder (OCD) has been published to date. Nowadays OCD is increasingly speculated to be a different disorder than other anxiety disorders, and rather is considered to be more similar to psychotic disorders. The objective of this study to explore whether there is an association of ceruloplasmin with OCD as in schizophrenia.Method26 pure OCD and 9 co-morbid OCD patients from Gaziantep University Sahinbey Research Hospital, Psychiatry Clinics, diagnosed according to the DSM IV and 40 healthy controls were included in the study. Blood samples were collected; ceruloplasmin levels were measured.ResultsThe mean ceruloplasmin level in pure OCD patients, co-morbid OCD patients, and control group persons were 544.46 ± 26.53, 424.43 ± 31.50 and 222.35 ± 8.88 U/L respectively. Results of all 3 groups differ significantly. Positive predictive value of ceruloplasmin for that cut-off point is 31/31 (100%) and negative predictive value is 40/44 (91%) in our group.ConclusionAlthough the nature of relationship is not clear there was an association between ceruloplasmin levels and OCD in our study.

Effective treatment of catatonia by combination of benzodiazepine and electroconvulsive therapy.

Objective Catatonia, a motor dysregulation syndrome, can emerge in numerous psychiatric disorders, mainly in schizophrenia and mood disorders, and metabolic and endocrine disorders such as infections, toxic states, epilepsy, and traumatic brain injury. In our study, we aimed to investigate demographic, clinical, and treatment-related characteristics of catatonic patients managed in our inpatient clinic. Methods The medical records of 57 patients diagnosed to have catatonia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the inpatient psychiatry clinic of the Gaziantep University School of Medicine between 1 January, 2003, and 31 December, 2011, were retrospectively reviewed. Results In patients with catatonia, mood disorders (63.2%) were found to be the most common underlying or primary disease, whereas mutism (47.4%) was found to be the most common catatonic symptom. There was a comorbid medical condition in 9 patients (15.8%). Patients underwent an average of 9.00 electroconvulsive therapy (ECT) sessions. Among 57 patients with catatonia, catatonic symptoms were resolved in 57 patients (100%) by benzodiazepine and ECT. Conclusions In our study, full recovery was achieved in catatonia by benzodiazepine plus ECT combination. As a result, we recommend combined ECT and benzodiazepine for catatonia.

Lack of pain in schizophrenia: a patient whose arm was burned and amputated

Diminished pain sensitivity or loss of pain sensation in schizophrenic patients has previously been reported. We report an interesting case of a schizophrenia patient who had the disease for 20 years and who had his forearm amputated below the elbow level due to severe burn injury to his muscles, tendons, nerve fibers and bone tissue, caused by direct exposure to flames from a liquefied petroleum gas cylinder, in an attempt to make himself warm during a medicine-free period with active symptoms and without pain sensation.

Are oxidative stress markers useful to distinguish schizoaffective disorder from schizophrenia and bipolar disorder

Objective Schizoaffective disorder is a disease with both affective and psychotic symptoms. In this study, we aimed to compare oxidative metabolism markers of schizoaffective disorder, bipolar disorder and schizophrenic patients. Furthermore, we also aimed to investigate whether schizoaffective disorder could be differentiated from schizophrenia and bipolar disorder in terms of oxidative metabolism. Methods Total oxidant status (TOS) and total antioxidant status (TAS) were measured in the blood samples that were collected from schizoaffective patients (n = 30), bipolar disorder patients (n = 30) and schizophrenic patients (n = 30). Oxidative stress index (OSI) was calculated by dividing TOS by TAS. Results TOS and OSI were found to be higher in patients with schizoaffective disorder compared with those in schizophrenia and bipolar disorder patients. TAS was not significantly different between the groups. Conclusion Schizoaffective disorder was found to be different from bipolar disorder and schizophrenia in terms of oxidative parameters. This result may indicate that schizoaffective disorder could differ from bipolar disorder and schizophrenia in terms of biochemical parameters. Increased TOS levels observed in schizoaffective disorder may suggest poor clinical course and may be an indicator of poor prognosis.

İki uçlu bozukluk’ta tedavi uyumu

Amaç: İki Uçlu Bozukluk (İUB), kronik seyri nedeniyle sürdürüm tedavisini gerektiren ve bu yüzden etkin tedavi için yüksek düzeyde hasta uyumunun zorunlu olduğu bir hastalıktır. İUB’de tedaviye uyumsuzluk, nüks ve yinelemenin ana sebebi olarak düşünülür. Bu çalışmada, en az bir yıl öncesinden psikiyatri polikliniğinde kaydı olan ötimik iki uçlu hastalarda: son bir ayda ilaç tedavisine uyum düzeyinin, uyumu etkileyen sosyodemografik, klinik özelliklerin ve son bir yıl içerisindeki takip muayene sayıları ile tedavi uyumu arasındaki ilişkinin araştırılmasını amaçladık. Yöntem: Malatya Devlet Hastanesi Psikiyatri Polikliği’ne başvuran 18 yaşından büyük, DSM-IV’e göre İUB tanısı konulmuş ve en az bir yıldır bu tanı ile poliklinik takibinde olan ötimik, 147 hasta çalışmaya alındı. 01-28 Şubat 2011 tarihleri arasında takip muayenesine gelen hastaların eşzamanlı olarak hastane bilgisayar kayıtlarına bakıldı. 01 Şubat 2010’dan itibaren bilgisayar kaydı olanlar çalışmaya alındı ve kaç defa takip muayenesine geldiği kayıtlardan tespit edildi. Çalışmaya aldığımız hastaların demografik değişkenlerini, klinik özelliklerini, hastalığı ve tedavisi ile ilgili tutumlarını içeren bilgiler hazırladığımız Veri Toplama Formu’na kaydedildi. Hastalar, son bir ay içerisinde ilaç kullanmadığı ya da düzensiz kullandığı gün sayısı 7’den az olanlar tedaviye uyumlu, 7’den fazla olanlar tedaviye uyumsuz olarak iki gruba ayrıldı. Verilerin istatistiksel analizi SPSS 16.0 ile yapıldı. Tedaviye uyumlu ve uyumsuz grupların verileri karşılaştırıldı. Bulgular: Hastaların, 108’i (%73.5) tedaviye uyumlu, 39’u (%26.5) tedaviye uyumsuzdu. Eğitim düzeyi (8 yıl temel alındı) uyumlu grupta daha yüksekti (p<0.001). Uyumlu grupta hastanede yatış oranı, uyumsuz gruba göre daha düşüktü (p<0.05). Uyumlu grupta son bir yılda takip muayenelerine devam etme oranı (p<0.001) ve hastalığına karşı içgörü oranı daha yüksekti (p<0.001). Her iki grup arasında şu anda kullandığı ilaç veya ilaç kombinasyonları açısından fark yoktu (p>0.05). Uyumlu grup, hastalığı ve tedavisi hakkında uyumsuz gruba göre daha fazla bilgilendirildiğini düşünüyordu (p<0.001). Uyumsuz grupta, tedaviden fayda görmediğini düşünerek (p<0.05) ve iyileştiğini düşünerek ilacı bırakma oranı daha yüksekti (p<0.001). Ayrıca, iyileştiğini düşünerek tedaviyi bırakma oranı tedaviden fayda görmediğini düşünerek ilaç bırakma oranına göre daha yüksekti (p=0.04, χ=8.64). İlaç kullanmaktan hoşnutsuz olma uyumsuz grupta daha yüksekti (p<0.05) Sonuç: Bu araştırmada, düşük eğitim düzeyi, hastalıkla ilgili yetersiz bilgilendiğini düşünme, içgörü eksikliği, tedaviden hoşnutsuz olma gibi veriler tedaviye uyumsuz grupta daha fazla bulundu. Ayrıca, tedaviye devam etmemenin en önemli sebebinin iyileştiğini düşünerek ilacı bırakma olduğu saptandı.