Suat Kucukgoncu

Antipsychotic‐induced weight gain in first‐episode psychosis patients: a meta‐analysis of differential effects of antipsychotic medications

AIM The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. METHODS A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. RESULTS Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. CONCLUSION Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

OBJECTIVE This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment. METHODS This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed. RESULTS After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR]=1.38, 95% confidence interval [CI]=1.08-1.58); mean hospitalizations, .33±.70 versus .68±.92 (p=.02); and mean bed-days, 5.34±13.53 versus 11.51±15.04 (p=.05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat=5; CI=2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR=1.40, CI=1.18-1.48) and showed salutary trends in global functioning measures. CONCLUSIONS This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses.

Skin Picking in Turkish Students: Prevalence, Characteristics, and Gender Differences.

The aim of this study is to investigate the prevalence, characteristics, triggers, and consequences of skin picking (SP) in a sample of Turkish university students, with an emphasis on gender differences. A total of 245 students from two universities in Turkey were assessed by using the Skin Picking Inventory. In total, 87.8% of the students reported engaging in SP, and 2.04% of the students had pathological SP. There was no statistically significant difference between female and male students regarding the frequency of SP and the estimated daily SP time. The SP episodes began earlier in men than in women. Women were found to pick their chins, whereas men were found to pick their legs more frequently. SP is prevalent among Turkish students. Triggers, characteristics, and consequences of SP in Turkish students are similar to the results reported in studies conducted on different cultures. Large-scale studies are needed to further investigate gender differences in SP.

Optimal management of night eating syndrome: challenges and solutions

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.

Clinical features of night eating syndrome among depressed patients.

OBJECTIVE The aim of this study was to investigate the frequency and clinical features of night eating syndrome (NES) in a sample of patients with depression. METHODS The study sample consisted of 155 depressed outpatients. Socio-demographic Form, Beck Depression Inventory, Beck Anxiety Inventory, Maudsley Obsessive-Compulsive Inventory, Pittsburgh Sleep Quality Index (PSQI) and Night Eating Questionnaire were utilised for data collection. RESULTS Night eating syndrome was identified in 21.3% of the patients. Comparisons between NES and non-NES patients revealed significant differences in BMI, smoking status, Beck Depression Inventory, Beck Anxiety Inventory, rumination and PSQI sub-scores for sleep quality, latency, disturbances and daytime dysfunction. In our sample, the predictors of NES were BMI, smoking and the subjects score on the PSQI sleep disturbances subscale. CONCLUSIONS Night eating syndrome is negatively associated with sleep, severity of anxiety and depression. Our findings suggest that there is a complex relation between NES and depression, and it is recommended that depressed patients be evaluated for NES.

Alpha‐lipoic acid (ALA) as a supplementation for weight loss: results from a meta‐analysis of randomized controlled trials

Obesity is associated with significant morbidity and mortality rates. Even modest weight loss may be associated with health benefits. Alpha‐lipoic acid (ALA) is a naturally occurring antioxidant. Studies have suggested anti‐obesity properties of ALA; however, results are inconsistent. The purpose of this study is to conduct a meta‐analysis of the effect of ALA on weight and body mass index (BMI).

Childhood trauma and dissociation in tertiary care patients with migraine and tension type headache: A controlled study

OBJECTIVE The aims of this study were: i) to compare the severity of somatoform and psychoform dissociation and childhood trauma among migraine patients, tension-type headache patients (TTH), and healthy controls; and, ii) to identify any relationships between headache characteristics and dissociative symptoms and traumatic childhood experiences among tertiary care patients with headache. METHODS The study sample consisted of 79 patients with migraine, 49 patients with TTH and 40 healthy controls. They completed the socio-demographic form, Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ). RESULTS The average score for childhood emotional abuse was significantly higher in the TTH and migraine patients than in healthy controls; mean scores for emotional neglect and physical abuse were higher in TTH patients than healthy controls; and the total CTQ score was higher in TTH patients than in either migraine patients or healthy controls. Average DES scores were significantly higher in TTH patients versus migraine patients and controls; and SDQ scores were higher in both headache groups than in controls. Headache duration and severity were found to be significantly related to childhood abuse scores among migraine but not TTH patients. CONCLUSION Our findings support the evidence of a relationship between childhood trauma and migraines, and suggest that childhood traumatic events are common and deleteriously effect migraine characteristics. Also our study suggests that childhood trauma may have a role in TTH. Significant differences in the DES and SDQ scores between groups may be explained by the differences in childhood trauma experiences.

Night Eating Syndrome in Major Depression and Anxiety Disorders

INTRODUCTION The purpose of this study is to investigate the prevalence and the clinical features of night eating syndrome (NES) in patients with depression and anxiety disorders. METHOD The study was conducted at Bakırköy State Hospital for Mental Health and Neurological Disorders. Three-hundred out-patients who had major depression (MD), panic disorders (PD), general anxiety disorders (GAD) and obsessive-compulsive disorders (OCD) participated in the study. The semi-structured socio-demographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Night Eating Questionnaire, and NES Evaluation Questionnaire were implemented. RESULTS In our sample, the prevalence of the NES was 15.7% (n=47). NES frequency was significantly higher in the patients diagnosed with major depression (MD 22%, GAD 7.8%, OCD 12.5%, PD 14%). Smoking, presence of past suicide attempts, rates of antipsychotic drugs use, and average scores of body mass index (BMI) were significantly higher in the patients who had NES. In this sample, depression, BMI, and smoking were found to be determinants of NES. CONCLUSION This study shows that NES may be frequently observed in patients admitted to psychiatric clinics, especially in those with major depression. Evaluation of NES in psychiatric patients may help the treatment of the primary psychopathology and prevent the adverse effects, like weight gain, which may reduce the quality of life.

Relationship Between Dissociative Experiences, Abnormal Sleep Experiences, and Sleep Quality in Undergraduate Students

Relationship between dissociative experiences, abnormal sleep experiences, and sleep quality in undergraduate students Objective: To investigate the association between dissociative experiences, sleep related experiences and sleep quality. Method: 127 undergraduate students have completed the Dissociative Experiences Scale (DES), the Iowa Sleep Experiences Scales (ISES) and the Pittsburg Sleep Quality Index (PSQI). Results: DES total and DES Taxon scores were moderately correlated with total ISES and ISES General Sleep Experiences (GS) subscale scores. PSQI total scores as well as the scores from PSQI subscales of sleep disturbances, use of sleeping medication and daytime dysfunction were weakly correlated with total ISES and ISES GS subscale scores. DES and PSQI total and subscale scores were not correlated with the lucid dreaming (LD) subscale of ISES. DES total scores explained a considerable amount of variance in ISES GS scores. Sleep disturbances and use of sleeping medication as indicators of sleep problems, were related to ISES GS. Conclusions: The present study showed the association between dissociative experiences and nighttime experiences and further revealed that some aspects of general sleep quality, especially the ones related to sleep problems are also related to both dissociation and general sleep experiences.

Antiepileptik barbeksaklon (maliasin®) bağımlılığı olan iki olgu

Two cases with antiepileptic barbexoclone (maliasin®) addiction Barbexoclone (Maliasin®) is an antiepileptic drug, which has been found to be effective in the treatment of epilepsy. Inpatient treatment seeking cases with the diagnosis of barbexoclone abuse accumulate. In this report, we presented 2 inpatient cases in an addiction treatment center with barbexoclone dependence. Also we discussed the non-medical use of prescribed drugs according to these cases.