Serdar Süleyman Can

Investigation of Heschl's gyrus and planum temporale in patients with schizophrenia and bipolar disorder: A proton magnetic resonance spectroscopy study

BACKGROUND Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. METHODS Thirty patients with schizophrenia (38.67±12.46years of age), 28 euthymic patients with bipolar I disorder (35.32±9.12years of age), and 30 age-, gender- and education-matched healthy controls were enrolled. Proton magnetic resonance spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschls gyrus and planum temporale of superior temporal cortices. RESULTS There were significant abnormalities in glutamate (Glu) (F(2,78)=8.52, p<0.0001), N-acetyl aspartate (tNAA) (F(2,81)=5.73, p=0.005), creatine (tCr) (F(2,83)=5.91, p=0.004) and inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. CONCLUSION As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder.

Dandy Walker Variant and Bipolar I Disorder with Graphomania

Cerebellum is known to play an important role in coordination and motor functions. In some resent studies it is also considered to be involved in modulation of mood, cognition and psychiatric disorders. Dandy Walker Malformation is a congenital malformation that is characterized by hypoplasia or aplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle and enlargement of the posterior fossa. When the volume of posterior fossa is normal, the malformation is called Dandy Walker Variant. Case is a 32 year old male with a 12 year history of Bipolar I Disorder presented with manic and depresive symptoms, including dysphoric and depressive affect, anhedonia, suicidal thoughts and behaviours, thoughts of fear about future, overtalkativeness and graphomania, increased energy, irregular sleep, loss of appetite, increased immersion in projects, irritability, agressive behavior, impulsivity. Cranial Magnetic Resonance Imaging was compatible to the morphological features of Dandy Walker Variant.

Neurochemical Differences Between Bipolar Disorder Type I and II in Superior Temporal Cortices: A Proton Magnetic Resonance Spectroscopy Study

BACKGROUND Despite the diagnostic challenges in categorizing bipolar disorder subtypes, bipolar I and II disorders (BD-I and BD-II respectively) are valid indices for researchers. Subtle neurobiological differences may underlie clinical differences between mood disorder subtypes. The aims of this study were to investigate neurochemical differences between bipolar disorder subtypes. METHODS Euthymic BD-II patients (n = 21) are compared with BD-I (n = 28) and healthy comparison subjects (HCs, n = 30). Magnetic Resonance Imaging (MRI) and proton spectroscopy (1H MRS) were performed on a 3T Siemens Tim Trio system. MRS voxels were located in the left/right superior temporal cortices, and spectra acquired with the single voxel Point REsolved Spectroscopy Sequence (PRESS). The spectroscopic data were analyzed with LCModel (Version 6.3.0) software. RESULTS There were significant differences between groups in terms of glutamate [F = 6.27, p = 0.003], glutamate + glutamine [F = 6.08, p = 0.004], inositol containing compounds (Ino) (F = 9.25, p < 0.001), NAA [F = 7.63, p = 0.001] and creatine + phosphocreatine [F = 11.06, p < 0.001] in the left hemisphere and Ino [F = 5.65, p = 0.005] in the right hemisphere. Post-hoc comparisons showed that the BD-I disorder group had significantly lower metabolite levels in comparison to the BD-II and the HC groups. LIMITATIONS This was a cross-sectional study with a small sample size. In addition, patients were on various psychotropic medications, which may have impacted the results. CONCLUSIONS Neurochemical levels, in the superior temporal cortices, measured with 1H-MRS discriminated between BD-II and BD-I. Although further studies are needed, one may speculate that the superior temporal cortices (particularly left hemispheric) play a critical role, whose pathology may be related to subtyping bipolar disorder.

Serum lithium levels are associated with white blood cell counts in bipolar disorder

* Correspondence: miatagun@ybu.edu.tr To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively in psychiatric disorders. Previous studies have reported alterations in the number (1,2) and function (3) of blood cells in psychiatric disorders. Alterations might be related to different etiologies in different psychiatric disorders (1) and medications (4,5). After the reversal of these mechanisms by successful treatment with escitalopram, the platelet volumes were normalized in first episode, medication-naive patients with major depressive disorder (6). In bipolar disorder, mood stabilizers seem to be the major reason for the changes in blood cells (4,5). In patients with psychotic spectrum disorders, the mean platelet volume (MPV) is increased, especially in patients on atypical antipsychotics (7). We have analyzed the blood cell counts of outpatients in our clinic between 1 January, 2012 and 31 December, 2014. Major depressive disorder (n = 338), bipolar disorder (n = 389), and psychotic spectrum disorders (n = 227) were the diagnostic groups examined in our analysis. The results of the comparison between the groups are presented in Table 1. These results confirm the previous study results, which reported increased leukocytes and decreased erythrocytes and platelets in bipolar disorder. Lithium (Li) increases the number of leukocytes in circulation (4,8–10). We further compared hematological parameters in patients on Li (n = 124), patients on valproate (VPA) (n = 203), and patients not taking a mood stabilizer (n = 51) in the bipolar disorder group (Table 2). Since Li and VPA have similar mechanisms of action, we proposed that VPA might also have effects similar to those of Li. However, there were differences in the platelet distribution width (which was higher in VPA-treated patients than in mood stabilizer-free patients with bipolar disorder, P = 0.006), platelet counts (which were lower in VPA-treated patients than in Li-treated patients (P = 0.000002) and mood stabilizer-free patients with bipolar disorder (P = 0.040)), WBCs (which were lower in VPA-treated patients than in Li-treated patients, P = 0.000076), and red blood cell counts (which were lower in VPA-treated patients Received: 30.05.2015 Accepted/Published Online: 13.09.2015 Final Version: 23.06.2016 Letter to the Editor

Misophonia: a disorder for social world

Dear Editor, Chewing, coughing, breathing, typing are activities that produce low level sounds and these audible activities are frequently encountered in the society. These background sounds are usually ignored in public places or at home. Some people may not ignore and perceive these sounds and become disgusted. Reasons of disgust are distraction and anger. Tension might be followed by anger which may then generate urge to leave the environment or intercept the background noise. Sensitivity to the group of background noise is called misophonia. 1-3 The term consists of two words: misos (strong hate or disgust) and phonia (sound) and was introduced by Margaret and Pavel Jastreboff in 2001. 4 It was aimed to present and discuss two cases of misophonia in this letter to the editor. The first case was a young man with generalized anxiety disorder. He was also suffering from misophonia and misophonia triggered anger. He reported that particularly his family life was devastated because of his anger. The second patient was suffering from obsessive compulsive disorder and misophonia. She reported that she was counting to ten, breathing slowly or leaving the environment as soon as possible, if she cannot relax. She was frequently listening music with headphones in public places to avoid from disgusting sounds. Both patients reported that they could not express themselves during their disgust, because of inhibiting themselves due to the fear of being called crazy. Misophonia is defined as immediate negative psychological responses to certain sounds that most people do not notice. 1-3 This novel psychopathology is proposed to be involved with dysregulation of emotional processing with a neurobiological basis. 5 Current classification systems have not defined misophonia yet and it is not clear whether it is a distinct entity or a dimension or symptom domain which accompany other disorders. 3 Post-traumatic stress disorder was the most frequently accompanying disorder in a recent large-scale study. 6 Accordingly, other psychopathologies may trigger or enhance the responses and therefore misophonia might be a dimensional concept. Misophonia may deteriorate quality of life and social functioning and thus should be further investigated. 1-3,5 A Google search with the key words “misophonia treatment” retrieved 217 results in the date of January 12th. 8 of the web pages’ name was including the term “misophonia”. Increased awareness of this problem would be useful in order to develop better treatments. 7,8

Situs Inversus Totalis and Schizophrenia Comorbidity

The comorbidity of structural or genetic diseases with schizophrenia is seen as an opportunity to understand the formation of schizophrenia. This case report presents a patient with comorbidity of schizophrenia, tetralogy of Fallot (TOF) and total situs inversus. TOF is a cyanotic heart disease, which can be linked to 22q11 deletion and trisomy 21. Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs, including the heart, are positioned in a mirror image from normal conditions. The comorbidity of TOF and SIT is quite rare. In our case report, schizophrenia is added to this rare comorbidity. This case report discussed the comorbidity and probable causal relationships. Furthermore, the research method of how transposition in internal organs is reflected in brain lateralization is also presented.

Effect of familial Mediterranean fever on sexual and reproductive health in women

BACKGROUND/AIM The aim of this study was to investigate the relationship between familial Mediterranean fever and female sexual dysfunction and premenstrual syndrome. MATERIALS AND METHODS This study included 36 patients with familial Mediterranean fever and 33 healthy volunteers. Familial Mediterranean fever was diagnosed according to the Tel Hashomer criteria and familial Mediterranean fever mutations were identified in all of the patients. The patients and healthy volunteers were compared in terms of anxiety, depression, sexual dysfunction, and premenstrual syndrome, and a model was created that describes the relationships among these variables. RESULTS We found statistically significant differences between the groups in terms of anxiety, premenstrual syndrome, and Golombok Rust Inventory of Sexual Satisfaction frequency and vaginismus subscale scores. There was no difference in depression scores between the groups. CONCLUSION Familial Mediterranean fever is a rheumatic disease that predisposes patients to sexual dysfunction and premenstrual syndrome, which emerges as direct and indirect psychological factors.

A Case of Ileus in a Patient with Schizophrenia Under Paliperidone Palmitate Treatment

Constipation is a side effect of antipsychotic drugs that have high affinity for muscarinic cholinergic receptors. In addition, ileus is an important side effect of antipsychotic treatment, with potentially morbid and mortal consequences if early detection fails. In this report, a colonic ileus case is described in a patient with schizophrenia under the treatment of paliperidone palmitate. Consequently, complete physical examination and close screening of side effects are recommended when antipsychotics are prescribed.

Suicide with thinner injection

Abstract Suicide is one of the major public health problems worldwide. Ingestion of the drugs is commonly used for suicide; however, injection of chemicals is a rare method (Güz et al., 2010). Especially, thinner injection is an unusual method and is used for suicide in a few cases. Thinner is one of the abused inhalants which are formed by toluene, ethyl acetate, and isobutanol, and are widely used in industry (Carabez-T et al., 1998). These toxic agents are usually taken in through inhalation. This report aims to inform about an unusual case attempted suicide by thinner injection into left subcutaneous tissue of neck.