Şenol Turan

Minor physical anomalies and neurological soft signs in patients with schizophrenia and their siblings

Neurological soft signs (NSSs) and minor physical anomalies (MPAs) are consistently found at higher rates in individuals with schizophrenia compared to healthy controls. However, limited research has been conducted on these traits among the biological relatives of these patients. We aimed to identify the possible origins of these traits in schizophrenia by exploring them in patients with schizophrenia, their healthy siblings and normal controls. Ninety-six patients with schizophrenia, their 66 non-psychotic siblings and 52 healthy subjects were studied. Measures included the Neurological Evaluation Scale, a structured examination for detection of minor physical anomalies, stroop and verbal fluency tests for cognitive assessment, and scales for assessment of disease severity in patients; the Scale for the Assesment of Negative Symptoms and the Scale for the Assesment of Positive Symptoms. Increased rates of NSSs and high MPA scores were found in both the patients and their siblings as compared to normal controls. MPAs in several body regions were similar (eyes, ears, hands and feet) or correlated (innercanthal width and head circumference) between patients and their respective siblings. However, there was little similarity in palate and tongue anomalies between these subjects. These results suggest that NSSs and MPAs might represent two distinct markers of risk for schizophrenia. MPAs at different locations may also represent distinct pathological processes, such that palate and tongue abnormalities are more likely to represent non-familial rather than familial factors compared to other abnormalities.

Factors associated with the duration of untreated illness among patients with obsessive compulsive disorder

BACKGROUND Patients suffering from obsessive compulsive disorder (OCD), despite heightened levels of functional impairment and disability, often wait several years before starting pharmacological treatment. The interval between the onset of a specific psychiatric disorder and administration of the first pharmacological treatment has been conceptualized as the duration of untreated illness (DUI). The DUI has been increasingly investigated as a predictor of long-term outcomes for OCD and other anxiety disorders. The present study investigated DUI, and demographic-clinical factors associated with DUI, among a sample of patients with OCD. The relationships between DUI, insight, and treatment outcomes were also assessed. METHODS We evaluated 96 subjects with a DSM-IV diagnosis of OCD using the Structured Clinical Interview for DSM-IV Axis I disorders, a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and a questionnaire designed by our group to identify reasons for delaying psychiatric admission. Patients with OCD showed a mean DUI of 84 months. However, DUI was not predictive of remission defined by a Y-BOCS total score of 10. Using the median value, a categorical cut-off for DUI of 4 years was calculated. RESULTS For patients with a shorter DUI (≤4 years), the age of OCD onset was significantly older than patients with a longer DUI (>4 years) (p<.001). The following four items related to reasons for delaying treatment were significantly endorsed by patients: the fact that symptoms were spontaneously fluctuating over time (61.5%), believing that OCD symptoms were not associated with an illness (60.4%), believing that one can overcome symptoms by him/herself (55.2%), and not being significantly disturbed by OCD symptoms (33.3%). Delaying treatment because of perceived social stigma was only endorsed by 12.5% of patients. Believing that OCD symptoms were not associated with an illness was significantly associated with a longer DUI (p=.039). CONCLUSIONS Results from the present study suggest that patients with OCD show a significant inclination toward delaying treatment admission. However, DUI was not predictive of remission in terms of symptomatology. Believing that OCD symptoms are not associated with an illness might indicate impairment in insight, a denial of the problem or could be associated with awareness of OCD as a mental illness. Factors related to the nature and course of OCD appear to be important determinants in delaying treatment among patients with OCD.

Prolonged anorexia nervosa associated with female-to-male gender dysphoria: A case report.

Transsexual (TS) individuals seem to display an increased risk in having eating disorders. Several case reports describe TS individuals with anorexia nervosa (AN). In order to understand better the impact of gender dysphoria (GD) and hormonal/surgical treatments on the occurrence and course of eating disorders in TS patients long term follow-up studies are needed. We present here a 41-year-old female-to-male TS patient suffering from AN. History revealed that pathological eating habits could strongly be associated with her GD. Hormonal and surgical treatments resulted in substantial improvement in the given eating disorder. The impact of GD on the development and treatment of eating disorder is discussed in this report.

Decreased Expression of α-Synuclein, Nogo-A and UCH-L1 in Patients with Schizophrenia: A Preliminary Serum Study

Objective α-synuclein, Nogo-A and Ubiquitin C-terminal hydrolase L1 (UCH-L1) have neuromodulatory roles for human brain. Therefore, abnormalities of these molecules are associated with neuropsychiatric disorders. Although some serum studies in the other disorders have been made, serum study of α-synuclein, Nogo-A and UCH-L1 is not present in patients with schizophrenia and healthy controls. Therefore, our aim was to compare serum levels of α-synuclein, Nogo-A and UCH-L1 of the patients with schizophrenia and healthy controls. Methods Forty-four patients with schizophrenia who is followed by psychotic disorders unit, and 40 healthy control were included in this study. Socio-demographic form and Positive and Negative Syndrome Scale (PANSS) was applied to patients, and sociodemographic form was applied to control group. Fasting bloods were collected and the serum levels of α-synuclein, Nogo-A and UCH-L1 were measured by ELISA method. Results Serum α-synuclein [patient: 12.73 (5.18–31.84) ng/mL; control: 41.77 (15.12–66.98) ng/mL], Nogo-A [patient: 33.58 (3.09–77.26) ng/mL; control: 286.05 (136.56–346.82) ng/mL] and UCH-L1 [patient: 5.26 (1.64–10.87) ng/mL; control: 20.48 (11.01–20.81) ng/mL] levels of the patients with schizophrenia were significianly lower than healthy controls (p<0.001). Conclusion Our study results added new evidence for explaining the etiopathogenesis of schizophrenia on the basis of neurochemical markers.

Olanzapine-induced atypical neuroleptic malignant syndrome in an adolescent man with anorexia nervosa

Anorexia nervosa (AN) is a serious mental illness that causes significant physical, emotional, cognitive, and social impairments. AN most often develops during adolescence or young adulthood and has high mortality and morbidity rates, in addition to cost burden. Current treatment of AN is multidisciplinary and is typically with a combination of medical, nutritional, and psychological interventions [1] . Antipsychotic medications have been especially used for weight gain and to treat body focused delusional thoughts in adolescent patients with AN [2]. Olanzapine is the most prominent second-generation antipsychotics (SGA) used for the treatment of this condition. However, although it is reported that these drugs are safe to use in adolescents with AN, side effects such as neuroleptic malignant syndrome (NMS) may vary in both the presenting and progressing features in patients with AN. NMS is a rare, idiosyncratic, and potentially fatal complication of antipsychotic medication. Cardinal features of NMS are muscle rigidity, hyperthermia, autonomic instability, and altered mental state. Laboratory findings are non-specific, but leukocytosis is common, and the levels of creatine kinase (CK) are often elevated. Approximately 66 % of NMS cases develop within the first week of initiating of antipsychotic treatment or a change of dose, and almost all cases develop within 30 days [1]. We report a case of an adolescent man with AN, who developed symptoms consistent with NMS after 2 days of treatment with a low dose of olanzapine, and although the symptoms of NMS had been resolved, these symptoms recurred after a month.

Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series

Treatment of severe and refractory manic episodes in hospital settings can occasionally be very difficult. In particular, severely excited patients showing aggressive, hostile, impulsive behaviours frequently require physical restraint and seclusion, high doses of antipsychotics and benzodiazepines, and sometimes, electroconvulsive therapy. Hospital stay is generally prolonged and such patients cause great emotional distress for other patients in the ward and clinical staff involved in their care. Here we report on three patients with a diagnosis of bipolar disorder and one patient with a diagnosis of schizoaffective disorder bipolar subtype, all of whom were hospitalized for severe manic episodes with psychotic features. These patients were extremely difficult to manage in the ward as no response could be obtained in the first week of treatment despite high doses of antipsychotics and benzodiazepine administration. The introduction and rapid titration of clozapine proved remarkably effective and was well tolerated in the acute management of these patients. We observed that clozapine had a superior and fast mood stabilization effect with rapid titration and could be extremely helpful in the management of such patients.

Affective temperaments in subjects with female-to-male gender dysphoria

BACKGROUND Males and females have different temperaments. In individuals with gender dysphoria (GD) there is marked incongruence between a person׳s expressed/experienced gender and their biological sex. The present study aimed to investigate the most common affective temperaments in individuals with female-to-male (FtM) GD. METHODS We performed a prospective and comparative study investigating affective temperaments in subjects with FtM GD. Eighty subjects with FtM GD and 68 female controls were enrolled. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was completed by all participants. RESULTS TEMPS-A scores were significantly higher in subjects with FtM GD for hyperthymic temperament (p≤0.001), whereas depressive (p≤0.001), anxious (p≤0.001), and cyclothymic (p=0.028) temperament scores were significantly higher in female controls. LIMITATIONS The study was limited by the lack of male-to-female subjects and male controls. CONCLUSIONS The results of our study indicate that individuals with FtM GD have significantly higher scores of hyperthymic temperament, measured by TEMPS-A. Biological basis underlying the development of gender identity independent from the biological sex might be related with affective temperaments.

Effects of electroconvulsive therapy on plasma levels of neuroactive steroids in inpatients with major depression.

Abstract Objectıve. Neuroactive steroids (NAS) are neuroactive molecules that have been shown to be associated with various psychiatric disorders. There are some inconclusive findings about the alteration in neuroactive steroid levels after the treatment of depression and ECT is still one of the most effective treatment choices for treatment resistant depression. Thus, we aimed to investigate the alterations of several NAS in plasma after ECT in inpatients with treatment resistant depression. Methods. In this study we enrolled 19 consecutive patients, 12 female and 7 male inpatients with major depression, who were not responding to medication, for whom ECT was Indicated, and were not taking any antidepressant treatment for at least a week prior to enrolment. We measured plasma progesterone, testosterone, pregnenolone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate, and estradiol levels before and after ECT. Results. The mean age of the participants was 38.3 ± 9.4 years. The mean plasma neuroactive steroid levels were insignificant between baseline and post ECT in patients with treatment resistant depression. Conclusıons. ECT does not seem to influence plasma neuroactive steroid levels in patients with treatment resistant depression. Additionally, plasma dehydroepiandrosterone and pregnenolone levels might be associated with improvement in depressive symptoms after ECT.

Total Tau and Phosphorylated Tau Protein Serum Levels in Patients with Schizophrenia Compared with Controls

Tau protein is located in the axons of neurons and in Alzheimer Disease, is abnormally phosphorylated and aggregates into paired helical filaments (neurofibrillary tangles) reflecting the degree of neurofibrillary pathology and neurodegeneration. Although tau and phosphorylated tau (p-Tau) pathology is a hallmark for dementia, few studies were performed in patients of schizophrenia. This preliminary serum study was designed to compare serum total tau and p-Tau levels of schizophrenia patients with healthy controls. The study was included 42 patients diagnosed with schizophrenia and 42 healthy control subjects. Sociodemographic form was applied to both groups and PANSS was applied to patient group. Serum total tau and p-Tau levels were measured by ELISA method. Total tau and p-Tau levels of patients were significantly lower than healthy controls. There was a positive correlation between amount of past electroconvulsive therapies and total tau level. However total tau and p-Tau levels were positively correlated. Our study results showed that serum total tau and p-Tau levels of patients with schizophrenia were significantly lower than healthy controls.

Binge Eating Disorder

Tikinircasina Yeme Bozuklugu, yeme davranisi uzerine kontrol kaybinin hissedildigi, tekrarlayan asiri yeme donemleriyle kendini gosteren ve kisinin tikinircasina yeme nobetlerinin yol acabilecegi etkileri giderebilmek icin bir takim yontemlere basvurmadigi bir yeme bozuklugudur ve Mental Bozukluklarin Tani ve Istatistiginin Elkitabi’nda yeni bir yeme bozuklugu olarak siniflandirilmistir. Tikinircasina Yeme Bozuklugu’nun, eriskinlerde gorulen en yaygin yeme bozuklugu oldugu ifade edilmektedir. Tikinircasina Yeme Bozuklugu’nda obeziteyle iliskili tibbi komplikasyonlar, yeme bozukluguna bagli psikopatolojiler ve baska ruhsal bozukluklar da gorulebilmektedir; ve butun bunlar kiside onemli rahatsizliklara yol acmakta, bireyin yasam kalitesinin dusmesine ve sosyal iliskilerinin bozulmasina neden olmaktadir. Tikinircasina Yeme Bozuklugu’nun tedavisi ilac tedavileri, psikoterapi ve bariatrik cerrahiden olusmaktadir. Bu derlemede, Tikinircasina Yeme Bozuklugu’nun tanimi, epidemiyolojisi, etiyolojisi, klinik ozellikleri ve agirlikli olarak tedavisi tartisilmistir.