Sibel Cakir

One year outcome in first episode schizophrenia : Predictors of relapse

AbstractThe aim of this study was to identify the predictors of outcome at one year follow–up after the first psychotic episode of schizophrenia. Seventy–nine first–episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow–up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.

Unrecognized depression in community-dwelling elderly persons in Istanbul

OBJECTIVE Depression, one of the most prevalent psychiatric disorders, causes disability and reduces quality of life. Rates of clinical depression in community samples of older adults range between 1-16%. Most studies of old age depression have been conducted in developed countries. The present study was conducted to determine the prevalence of depressive disorders among Turkish elderly in an urban community. METHOD This study was carried out in the Kadiköy district of Istanbul. The sample for the cross-sectional part of the study was 1067 individuals age 70 or older, randomly selected from population registries. Geriatric Depression Scale (GDS), Mini-mental State Examination (MMSE) scores and demographic data were obtained by face-to-face home interviews. The data were analyzed using regression analysis for each variable. RESULTS The study group consisted of 623 (61%) females and 395 (39%) males. The mean age was 74.8 years, with 63% of subjects aged 70-74, 29% between 75-84 years old and 8% aged 85 and above. Sixteen percent (n = 163) of the total group scored 14 or higher on the GDS. Only 9% of the depressed group were on antidepressant medication. Logistic regression analysis indicated that significant predictors for higher scores GDS scores were: illiteracy, aged 75-79 yrs, female sex and having 4 or more children. CONCLUSION Depression is a common but unrecognized and thus untreated problem among the elderly population in Turkey. While gender and age are unmodifiable, education level and multiparity can be altered. Education of caregivers and medical staff about old age depression may increase its rate of detection and facilitate improved treatment.

Association of a serotonin receptor 2A gene polymorphism with cognitive functions in patients with schizophrenia.

The aim of this study was to investigate the association between the T102C polymorphism on the 5HT2A gene and cognitive function as well as clinical manifestations in patients with schizophrenia. Eighty‐two outpatients with schizophrenia participated in this study. The Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of each patients symptoms. In order to evaluate their short‐term attention capacity, a Digit Span Test was used. The Continuous Performance Test (CPT) was used to test the sustained attention span of each of the subjects. Cognitive flexibility was measured with the Wisconsin Card Sorting Test (WCST). The polymorphism of the 5‐HT2A gene at codon 102 (T/C) was genotyped by sequence specific polymerase chain reaction. The T allele at codon 102 correlated with a lower hit rate and more commission errors in the CPT and patients with the heterogeneous genotype (TC) had more commission errors than those who were of homogeneous type (CC or TT). Patients with the TC genotype also had significantly fewer correct responses in the WCST compared to those who were type CC or TT. No relationship was found to exist between the C allele and cognitive variables. There was also no relationship established between the codon 102 polymorphism and clinical parameters. These findings suggest that the TC genotype might be related to certain cognitive impairments in patients with schizophrenia.

Electroconvulsive therapy in first-episode schizophrenia.

Abstract: Knowledge about the efficacy of electroconvulsive therapy (ECT) on schizophrenia comes from chronic patients and little known on young, first-episode patients. The aim of this study is to evaluate short-term and long-term efficacy of ECT in patients with first-episode schizophrenia. In the first phase of the study, 90 hospitalized, first-episode patients with schizophrenia were enrolled; psychopathology was evaluated with Brief Psychiatric Research Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) on admission and discharge. Antipsychotics were first-line treatment for most of the patients, but medication for nonrespondent catatonic patients and patients who had violent behaviors were treated with ECT. The patients who met the remission criteria were intended to a 1-year follow-up after discharge. BPRS, SAPS, and SANS were monthly recorded during the follow-up. Differences in clinical characteristics, relapse, and rehospitalization rates were analyzed in patients with or without ECT treatment. Thirteen patients were treated with ECT. They were low educated and were more likely nonparanoid subtypes (catatonic, disorganized). The ECT group had higher BPRS scores on admission and their hospitalization period was longer than the antipsychotic group. On the contrary, BPRS and SAPS scores of the ECT group were lower at discharge. The ECT group presented shorter follow-up duration than the antipsychotic group during the follow-up period. In conclusion, the efficacy of ECT was very satisfactory in acute term in first-episode schizophrenia, but the same efficacy was not continuous during the 1-year follow-up.

Does a psychoeducational approach reach targeted patients with bipolar disorder

OBJECTIVES The goal of this paper was to determine factors which are related to motivation of bipolar patients to attend a psychoeducation program. METHODS Patients with bipolar disorder which had at least four years of prospective follow-ups were invited to a 6-week psychoeducation program. Patients who accepted and those who refused the participation were compared using several clinical characteristics. RESULTS Of the 173 patients who were invited, 84 participated in the program. Participants had significantly more family history of bipolar disorder and suicide, good response to prophylactic treatment, full medication adherence, therapeutic blood levels of mood stabilizers, regular follow-up visits, mixed episodes, and significantly less total number of episodes. Presence of mixed episodes, full medication adherence and therapeutic blood level of mood stabilizers were found predictive for attendance in logistic regression analysis. CONCLUSIONS Our results suggest motivation and participation rates of patients who attended a psychoeducation program were constrained. Factors associated with a poor response to psychopharmacologic treatments also seem valid for non-attendance to the psychological interventions.

Quantitative Proton MR Spectroscopy Findings in the Corpus Callosum of Patients with Schizophrenia Suggest Callosal Disconnection

BACKGROUND AND PURPOSE: The callosal disconnectivity theory was previously proposed to explain the pathophysiology of schizophrenia. The goal of this study was to investigate the metabolic integrity of the corpus callosum in patients with schizophrenia by proton MR spectroscopy. MATERIALS AND METHODS: Twelve first-episode and 16 chronic patients meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia and 28 age- and sex-matched control subjects were enrolled in the study. We measured the absolute concentrations of neurometabolites and T2 relaxation times of tissue water (T2B) in the genu of the corpus callosum by using the internal water-reference method. The severity of symptoms in patients was rated by means of psychopathology scales. Differences in neurometabolite concentrations and T2B values between the patients and control subjects were assessed. We also investigated the correlation of metabolite concentrations with the severity of symptoms. RESULTS: N-acetylaspartate (NAA) concentrations were significantly lower in the first-episode as well as in chronic patients, compared with respective control subjects (P < .001). NAA concentrations in the first-episode and chronic patient groups were negatively correlated with both the Brief Psychiatry Rating Scale and the Scale for Assessment of Negative Symptoms scores (P < .001). There was a significant negative correlation between the NAA concentrations and the Scale for Assessment of Positive Symptoms scores in all patients (P = .028). T2B values were significantly higher in the patients, compared with the control subjects (P < .001). CONCLUSION: Decreased NAA concentration in the corpus callosum correlates with psychopathology in schizophrenia. This finding, together with prolonged T2B values of the corpus callosum, supports the previously proposed callosal disconnection theory concerning the pathophysiology of schizophrenia.

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

OBJECTIVE In this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features. METHOD The life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups. RESULTS The psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p=0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p=0.013). Episodes were more severe (p<0.001) and hospitalization rates were higher (p=0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p<0.001). CONCLUSION The well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.

The efficacy of mirtazapine in agitated patients with Alzheimer’s disease: A 12-week open-label pilot study

Agitation is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of agitated patients with Alzheimer’s disease (AD). The consecutive patients with AD who have significant agitation were assigned to a 12-week open-label, prospective study. Patients received mirtazapine 15–30 mg/day. The changes in Cohen-Mansfield Agitation Inventory-Short form (CMAI-SF) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirteen of 16 (81.25%) patients completed the study. There was a significant reduction in CMAI-SF and CGI-S between the pre- and post-treatment with mirtzapaine (p < 0.001). The mean baseline score was 26.54 ( ± 5.4) and mean reduction was 10.6 ( ± 7.5) in CMAI-SF. There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of agitated patients with AD.

Childhood trauma and treatment outcome in bipolar disorder

ABSTRACT The aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM–IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.

Evaluation of incidence and clinical features of antibody-associated autoimmune encephalitis mimicking dementia.

Background. Anti-neuronal autoimmunity may cause cognitive impairment that meets the criteria for dementia. Objective. Our aim was to detect the incidence and clinical features of autoimmune encephalitis imitating clinical findings of primary dementia disorders and to delineate the validity of anti-neuronal antibody screening in dementia patients. Methods. Fifty consecutive patients fulfilling the clinical criteria for primary dementia, 130 control patients, and 50 healthy controls were included. Their sera were investigated for several ion channel and glutamic acid decarboxylase (GAD) antibodies by a cell-based assay, radioimmunoassay, and ELISA, as required. Results. Sixteen patients satisfying dementia criteria had atypical findings or findings suggestive of autoimmune encephalitis. N-methyl-D-aspartate receptor (NMDAR) antibody was detected in a patient with dementia, Parkinsonism, and REM sleep behavior disorder (RBD) fulfilling the criteria for dementia with Lewy bodies (DLB). One control patient with bipolar disease displayed low anti-GAD antibody levels. Conclusions. Our study showed for the first time the presence of parkinsonism and RBD in an anti-NMDAR encephalitis patient mimicking DLB. Although autoimmune encephalitis patients may occasionally present with cognitive decline, most dementia patients do not exhibit anti-neuronal antibodies, suggesting that routine analysis of these antibodies in dementia is not mandatory, even though they display atypical features.