Selçuk Candansayar

Comparison of Clozapine- Amisulpride and Clozapine- Quetiapine Combinations for Patients With Schizophrenia Who Are Partially Responsive to Clozapine: A Single-Blind Randomized Study

Schizophrenia is a devastating psychiatric disorder. Clozapine has long been the gold standard for treatment of patients with treatment-resistant schizophrenia; however, some patients are only partially responsive to clozapine treatment. Augmentation of clozapine treatment might enhance its effectiveness in partial responders, but only a few studies have investigated possible augmentation strategies. This study compared the effectiveness and tolerability of the combination of amisulpride and clozapine with the combination of quetiapine and clozapine in patients who were only partially responsive to clozapine monotherapy. Fifty-six treatment-resistant patients who were partially responsive to clozapine were randomly assigned to receive amisulpride or quetiapine along with an ongoing stable dose of clozapine. Fifty patients completed the study. Patients were evaluated at baseline and at the first, third, sixth, and eighth weeks. Efficacy measures consisted of the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), and the Clinical Global Impression (CGI) scale. Tolerability and adverse effects were assessed with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and the Simpson Angus Scale (SAS). A substantial improvement occurred in both groups by the end of the eighth week; however, the improvement associated with amisulpride was significantly greater than that seen with quetiapine. This difference was noted as early as the third week of follow-up in terms of CGI scores, and by the sixth week with regard to BPRS, SANS, and SAPS scores. Both drugs were well tolerated, as measured by UKU and SAS. Improvement favoring clozapine+amisulpride could be attributed to the selective D2/D3 binding property of amisulpride, which had an additional effect in improving symptoms of schizophrenia. The authors concluded that amisulpride seems to be effective and well tolerated for augmentation purposes in clozapine-resistant patients.

Depression, Anxiety Levels and General Psychological Profile in Behçet’s Disease

Background: Behçet’s disease (BD) is a multisystem disease with unknown etiology. Until today, the role of emotional stress and the real incidence of psychiatric symptoms in this disease have not been clarified yet. Objective: In this study, we aimed to evaluate the general psychological profile of the patients diagnosed as having BD as well as their depression and anxiety levels in order to investigate the psychiatric aspects of this disease. Material and Methods: Twenty-three patients with BD and 17 patients with chronic plaque-type psoriasis who made up the control group were examined by the Beck Depression (BDI), Beck Anxiety (BAI) and Brief Symptom Inventories (BSI). Results: The mean BDI score of the BD group was 11.69 ± 6.93, and the corresponding value was 9.11 ± 7.34 for the psoriasis group. The mean BAI score of the BD group was 21.39 + 13.68 and this level was 12.41 ± 10.70 for psoriasis patients. The mean BSI score of the BD group was 61.30 ± 43.66 and it was 30.41 ± 28.77 for the control group. The mean BDI, BAI and BSI scores of the patients diagnosed as having BD were significantly higher than those of the control group (F = 0.234, F = 0.508, F = 0.549 and p < 0.05). Conclusion: BDI, BAI and BSI scales are useful to evaluate the psychiatric aspects of BD. The results of our study revealed that the collaboration of a dermatologist and psychiatrist is essential for the follow-up of patients with BD.

Cerebrovascular dynamics in patients with migraine: near-infrared spectroscopy study.

Migraine is hypothesized to be a neurovascular coupling disorder where the cerebral vascular reactivity is malfunctioning and measuring hemodynamic changes during migraine without causing more disturbance has always been a challenge. Functional near infrared spectroscopy system (fNIRS) is being proposed as an inexpensive, rapid, safe and accurate alternative to fMRI, transcranial doppler sonography (TCD). We have developed NIROXCOPE 201, a novel device for fNIRS which offers 16 source-detector pairs distributed on a probe that is placed on the forehead. Measuring hemodynamic changes during migraine without causing more disturbance has always been a challenge. Using NIROXCOPE 201, we have attempted to investigate the cerebrovascular reactivity of migraine patients to a breath hold task which produces a metabolic perturbation. Six normals and six migraine patients performed four consecutive breath holding task. We calculated the peak and latencies of the initial dip and recovery phases for [Hb], [HbO(2)], [tHb], and [OXY] signals. [Hb], [tHb], and [OXY] ID and R amplitudes of normals are approximately a magnitude higher than migraine patients (P<0.01), while latencies showed no significant differences. Data suggests an altered neurovascular coupling in frontal cortex of migraine patients interictally. The application of NIROXCOPE 201 to patients suffering from other primary headache disorders will reveal diagnostic as well as therapeutic implications of the presented study.

A Prospective Study of Serotonin Transporter Gene Promoter (5-HTT Gene Linked Polymorphic Region) and Intron 2 (Variable Number of Tandem Repeats) Polymorphisms as Predictors of Trauma Response to Mild Physical Injury

The aim of this study was to examine the effect of both promoter and intron polymorphisms of the serotonin transporter (5HTT) gene on posttraumatic stress disorder (PTSD) development. For this purpose, two polymorphisms of the 5-HTT gene, which are found in the promoter (5-HTT gene-linked polymorphic region) and second intron (variable number of tandem repeats) of the gene, were analyzed in 100 patients who were admitted to the Emergency Department after a mild physical trauma. None of the 5-HTT polymorphisms studied have an effect on PTSD development after a mild physical injury, but having L allele for 5-HTT gene-linked polymorphic region may cause milder hyperarousal symptoms in those patients who have developed PTSD.

Farewell to the world: suicide notes from Turkey

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

Suicide in Different Cultures: A Thematic Comparison of Suicide Notes From Turkey and the United States

Suicide is a global concern, hence, cross-cultural research ought to be central; yet, there is a paucity of cross-cultural study in suicidology. A thematic or theoretical-conceptual analysis of 60 suicide notes drawn from Turkey and the United States, matched for age and sex, was undertaken, based on Leenaars’s empirical-based multidimensional model of suicide. The results suggested that there were more culturally common factors than specific differences; yet, not consistent with previous cross-cultural studies of suicide notes, differences emerged in Turkey notes expressing more indirect and veiled communications (indirect expressions). Specifically, Turkish notes expressed that there may be more reasons to the act than the person writes. It was concluded that the model may be applicable to suicide in both countries, but also much greater cross-cultural study is warranted on specific cultural risk factors. A question raised is whether the findings are related to collectivism versus individualism.

Brief Report: Perceptions of Turkish Psychiatric Inpatients about Therapeutic Factors of Group Psychotherapy

Abstract Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples. The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom’s (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self–understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, and comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients’ and psychiatrist’s ratings showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross–cultural psychology.

Psychiatric findings related to neurological complications in Behcet's disease: A short review and a case presentation

Behcets disease affects the skin, mucosa, joints, vascular system, eyes, the central nervous system (CNS) and gastrointestinal system. In Behcets disease, the obvious illness mechanism in all organ systems is occlusive vasculitis of unknown etiology. CNS involvement in Behcets disease sometimes causes psychiatric disorders. In this paper we discuss a case with neurobehcet disease who was admitted with psychotic symptoms. This 29-year-old male patient had symptoms of Behcets disease and concomitant psychiatric symptoms. An advanced evaluation of the CNS was performed following unresponsiveness to antipsychotic treatment. It was concluded that the psychotic picture was a result of CNS involvement related to Behcets disease. Colchicine was added to the treatment and upon discharge the case was in remission. Differences in treatment and prognosis between psychiatric disorder due to Behcets disease and psychiatric disorders comorbid to Behcets disease are discussed.

How Game Addiction Rates and Related Psychosocial Risk Factors Change Within 2-Years: A Follow-Up Study

Objective Prospective data of risky online gamers in Turkey is missing. Therefore, we aimed to investigate the change in gaming behaviors and addiction rates of Travian players within two years to search diagnostic stability of internet gaming disorder and some psychosocial risk factors. Methods 110 responders completed the whole questionnaire package including 21-item Game Addiction Scale (GAS), Satisfaction with Life Scale (SLS), Rosenberg Self-Esteem Scale (RSES), and Multi-dimensional Scale of Perceived Social Support (MSPSS). A hierarchical linear modeling approach was followed to test the linear change in game addiction scores of the participants from 2013 to 2015. Results GAS scores of gamers significantly decreased within two years (p=0.026). MSPSS scores significantly and negatively associated with GAS scores (p<0.001) and the negative association of time remained significant (p=0.035). Decrement in the MSPSS scores in two years was associated with increment in GAS scores. 9 (90%) of 10 participants with internet gaming disorder according to monothetic format and 26 (52%) of 50 participants with internet gaming disorder according to polythetic format were found to not to meet the diagnosis in the follow-up. 33 out of all participants reported that they were not playing any online games for at least last 6 months. Conclusion Social support seems to be a protective factor for game addiction and diagnosis of internet gaming disorder has low temporal stability among Travian players in Turkey.

Systematizing cultural awareness: Toward a model for modification of trauma therapy and an application in Turkey

A cross-cultural team including a U.S.-trained clinical cross-cultural psychologist and two Turkish psychiatrists conducted research on a set of five trauma treatment psychotherapy groups for adult women survivors of sexual abuse in Ankara, Turkey. Based upon observational comparisons between trauma treatment groups in U.S. and Turkish settings, the team developed an approach to assist in adaptation of treatment methods from one cultural setting to another. This is a preliminary effort to develop a conceptual tool to focus the attention of therapists on salient dimensions of culture that may influence the psychotherapy process. This article describes six possible dimensions: (a) relational/individual self; (b) situationalism/universalism; (c) high/low power differential; (cc) high/low gender differential; (d) internal/external control; (e) emotional expressivity/containment; and (f) short-term/long-term time orientation. Comparative cultural examples from trauma psychotherapy group field notes illustrate the use of the tool.