Süheyla Ünal

The indices of endogenous oxidative and antioxidative processes in plasma from schizophrenic patients. The possible role of oxidant/antioxidant imbalance.

There is great evidence in recent years that oxygen free radicals play an important role in the pathophysiology of schizophrenia. The present study was performed to assess the changes in plasma nitric oxide (NO) and thiobarbituric acid-reactive substances (TBARS) levels, and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and xanthine oxidase (XO) activities in schizophrenic patients compared to age- and sex-matched normal controls. A hundred patients with schizophrenia and 51 healthy volunteers were included in the study. XO, SOD, and GSH-Px activities as well as NO and TBARS levels were estimated by standard biochemical techniques in the plasma of normal healthy controls and schizophrenia patients. In schizophrenia, increased plasma XO activity (P < .0001) and NO levels (P < .0001), decreased SOD activity (P < .0001), and unchanged GSH-Px activity were detected compared to control group. Plasma TBARS levels were increased in schizophrenic patients (P < .01), especially in the residual subtype. TBARS levels in nonsmoker schizophrenic patients were found to be higher than nonsmoker controls. Although TBARS levels in both patients and controls were found to be higher in smokers as compared to nonsmokers, it was not statistically significant. No effects of duration of the illness, gender, and low and high dose of daily neuroleptic treatment equivalent to chlorpromazine on oxidant and antioxidant parameters were observed. Because the dose and the duration of treatment with drugs have no influence on the results, it can be interpreted that the findings are more likely to be related mainly to the underlying disease. These findings indicated a possible role of increased oxidative stress and diminished enzymatic antioxidants, both of which may be relevant to the pathophysiology of schizophrenia. On the other hand, increased NO production by nitric oxide synthetases (NOSs) suggests a possible role of NO in the pathophysiological process of schizophrenia. These findings may also suggest some clues for the new treatment strategies with antioxidants and NO synthase (NOS) inhibitors in schizophrenia.

Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common psychiatric illness. Although the aetiology of OCD is still unknown, the family-genetic data show that familial forms of OCD may be associated with a specific genetic susceptibility. Recent investigations have associated development of OCD with infectious illness. Toxoplasmic encephalitis (TE) is a common presentation of Toxoplasma gondii infection of the central nervous system (CNS). The most commonly affected CNS region in TE is the cerebral hemisphere, followed by the basal ganglia, cerebellum and brain stem. The basal ganglia has been implicated in the development of OCD. Therefore, in this study, it was aimed to investigate a possible association between Toxoplasma infection and OCD. We selected 42 patients with OCD and 100 healthy volunteers, and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). The sero-positivity rate for anti-T. gondii IgG antibodies among OCD patients (47.62%) was found to be significantly higher than the rate in healthy volunteers (19%). This is the first report to examine a potential association between Toxoplasma infection and OCD. The main finding of the present study is an increased level of IgG antibodies to T. gondii in OCD patients when compared with the level in healthy controls. There might be a causal relationship between chronic toxoplasmosis and the aetiology of OCD.

Anxiety, depression and sexual dysfunction in women with chronic pelvic pain

Abstract In this article we compared healthy women with women having chronic pelvic pain (CPP) for the levels of depression, anxiety, and sexual dysfunction. A cross-sectional survey was conducted in the Obstetrics and Gynecology Outpatient Clinic and Family Planning Department of Inonu University Medical Faculty in Turkey. We examined 19 women with CPP and 25 healthy women between January 2000 and April 2000. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Spielberger Trait Anxiety Inventory (STAI), and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) were used for psychological assessments. Women with CPP had significantly higher scores on the BDI and GRISS. While avoidance, dissatisfaction and non-sensuality subscale scores of the GRISS showed a positive correlation with depression and anxiety scores, the vaginismus subscale score had a positive correlation with the BAI scores. Our results indicated that there is a link between anxiety, depression and sexual dysfunction in women with chronic pelvic pain. Further studies are needed to characterize this link.

Pituitary volume in patients with panic disorder.

Panic patients have many functional deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies have shown changed pituitary gland volume in some psychiatric disorders that have functional deficiencies in the HPA axis. However, to date no study has evaluated the pituitary gland volume in patients with panic disorder (PD). We investigated the pituitary gland volume in patients with PD (n=27) and age- and sex-matched healthy controls (n=27), using 1.5-T magnetic resonance imaging in this study. Analysis showed that patients with PD had significantly smaller pituitary volume compared to healthy subjects. Patients with agoraphobia especially had a significantly smaller pituitary volume than patients without agoraphobia. There was a significant relationship between the pituitary volume and both the severity of symptoms and the illness duration in the patient group. The results show that patients with PD have reduced pituitary volume, which may reflect the functional abnormalities seen in this disorder. These findings may help us better understand the pathology of PD.

Acute and chronic effects of electroconvulsive treatment on oxidative parameters in schizophrenia patients

Electroconvulsive therapy (ECT) is an effective treatment alternative for schizophrenia. Previous studies have already indicated the possible effects of oxidative stress in this disorder. However, there have been no previous studies evaluating the effects of ECT on the oxidative stress in these patients. We therefore aimed to investigate the acute and chronic effects of ECT on serum levels of oxidant and antioxidant molecules in schizophrenia patients (n=28). The serum MDA and CAT levels of the patients with schizophrenia were higher than that of the controls before ECT (n=20) but there was no significant difference in the serum NO and GSH levels of the patient groups compared to the controls. We found that the NO levels of the patients were higher than the controls in the group experiencing their first episode but not in the chronic group. There was a significant clinical improvement in the patients in terms of BPRS, SANS and SAPS reduction after the 9th ECT, but not the 1st ECT. Serum MDA levels were significantly reduced compared to the baseline after the 9th ECT session although there was no significant difference after the 1st session. Separate evaluation of the patient groups revealed that the significant MDA decrease following ECT was in the patients experiencing their first episode and not in the chronic group. No significant difference was noted in the serum levels of other oxidant and antioxidant molecules after either the 1st or 9th ECT session. These results suggest that ECT does not produce any negative effect on oxidative stress in patients with schizophrenia.

The neuropsychological and neurophysiological profile of women with pseudoseizure

OBJECTIVE Our aim in this study was to compare the assessments of neuropsychological tests and the p50 neurophysiological test of patients with seizure diagnosed as conversion disorder and healthy control subjects, and to investigate the neurological status in conversion disorder with pseudoseizure. METHODS A total of 22 female conversion disorder patients with convulsions diagnosed according to SCID-I/CV and 22 healthy women were included in the assessment. The participants were administered WMS-R, the cancellation test, and the Stroop test as neuropsychological tests and p50 was assessed as a neurophysiological test. RESULTS The patients results for the neuropsychological tests were found to be significantly low compared to the control group. The p50 sensory gating ratios of the patient group were statistically significantly lower than the controls. There was no significant correlation between the neuropsychological test scores and gating ratios of the patient and control groups. CONCLUSIONS This study is the first to check sensory gating in conversion disorder patients with pseudoseizure and its most important result is finding reduced p50 sensory gating in patients. Our results suggest that these patients have a neurological tendency to this disease due to functional neurophysiological features.

Help Seeking Behavior and Related Factors in Schizophrenia Patients: A Comparative Study of Two Populations from Eastern and Western Turkey

Help seeking behavior and related factors in schizophrenia patients: a comparative study of two populations from eastern and western Turkey Objective: In this study, it is aimed to investigate and compare the properties of help-seeking behaviour of schizophrenia patients from two districts situated in eastern and western Turkey. Method: Thirty one schizophrenia patients admitted to Tatvan State Hospital in 2006 and 41 schizophrenia patients admitted to Menemen State Hospital in 2007 were recruited in the study. All the patients were in remission. A semi-structured, short questionnaire type interview was carried out with the patients inquiring about their socio-demographic properties and the ways they explain and seek help for their illness. Results: The populations from Tatvan and Menemen significantly differed in terms of educational and income levels. Mean education duration of patients was 4.3±4.2 years for Tatvan and 6.8±3.5 years for Menemen (p=0.008). Fourty five percent of patients from Tatvan were of low income level and 54% of patients from Menemen were of middle-income level (p=0.016). Seventy four percent of all patients seeked help from religious sources for their illness. The percentage of patients seeking for psychiatric help was 85 for Menemen and 32 for Tatvan (p<0.001). Patients with education level of secondary-school and higher seeked for psychiatric help more than the less educated patients (p=0.039). Seventy one percent of all patients were advised to consult a psychiatrist by their family members. Discussion: This study revealed that a substantial proportion of schizophrenia patients from the two different districts were in seek of help from religious sources. Seeking for psychiatric help increased with

Travma sonrası hayata küsme bozukluğu ölçeğinin (PTED self-rating scale) Türkçe uyarlamasının geçerlilik ve güvenilirlik çalışması / The study of the realibility and validity of the Turkish version of post traumatic embitterment disorder self-rating scale (PTED self-rating scale)

The present study was performed to test the realibility and validity of the Turkish version of Post Traumatic Embitterment Disorder Self-Rating Scale (PTED Self-Rating Scale) which evaluates prolonged and disabling embitterment reactions in the aftermath of negative life events and to introduce the scale to clinical and nonclinical settings in Turkey. The PTED scale was administered to four independent groups of inpatients and normal people, a total of 1333 participants: 1. Inpatients with the PTSD diagnosis; 2. Inpatients with general psychiatric disorder diagnosis; 3. Normal people having no psychiatric diagnosis but experiencing a traumatic life events during the study applications; and 4. Normal people who experienced a traumatic life event in the past. Applications were performed in both face to face and group settings. Results showed that the internal consistency, test-retest reliability and split half reliability were high. Factor analysis indicated a two-factor solution, accounting for 54.47% of the total variance. The item loadings were 0.37 and higher. The analysis indicated that the PTED Scale has very good convergent and criterion validity. The PTED Scale is a reliable and valid measure for embitterment as an emotional reaction to a negative life event. It can be used for clinical and nonclinical populations in Turkey.

Does Psychodrama Affect Perceived Stress, Anxiety-Depression Scores and Saliva Cortisol in Patients with Depression?

Objective Little is known about the effects of psychodrama group therapy on the level of stress, anxiety and depression of the group members, and the biological markers of stress. The aim of this study test cortisol level as a biological reflection of some mental characteristics gained by the psychodrama method in coping with stress. Methods Depressive patients aged between 18 and 65 years, who diagnosed with depression according to DSM-5, without psychiatric comorbidity, who do not use drugs and were available for psychodrama were enrolled into the study. These patients were evaluated using the Perceived Stress Scale, State-Trait Anxiety Inventory and Beck Depression Inventory. In order to observe the circadian rhythm of cortisol, samples were collected from the participants before lunch, before dinner and before going to sleep on the day before psychodrama and on the 0, 15th, and 30th minutes after awakening in the morning of the psychodrama day; as well as just before and after the psychodrama session. Saliva cortisol level just before the initial session of psychodrama group therapy was compared with the saliva cortisol level just after the last psychodrama session at the end of 16 weeks. Results Statistically significant difference was determined between the scores of perceived stress scale, STAI-1, STAI-2, beck depression inventory and salivary cortisol level before and after psychodrama session. There was significant decrease in both the scale scores and salivary cortisol after vs. before psychodrama. Conclusion This results is important as it shows the biological aspect of clinical improvement. Further studies would provide us with better understanding of the effects of psychodrama group psychotherapy on depressive mood and biological projections by means of short-term and long-term follow-up studies.

Urinary retention in male patient associated with aripiprazole

Urinary retention and / or voiding difficulty are a rare side effect caused by the second generation antipsychotics. Aripiprazole has a lower incidence of adverse effects than other second generation antipsychotics (SGA) and aripiprazole can be used as an alternative treatment on patients who have urinary retention depending on antipsychotic use. Although there are limited data in literature about the effect of aripiprazole on urinary retention, a case was encountered urinary retention with the use of antidepressants and aripiprazole together. Also there is only one case in the literature about urinary retention occurred with aripiprazole. Our case emerged urinary retention with the addition of aripiprazole while under treatment of paroxetine. Patient’s complaints have stopped with the discontinuation of aripiprazole and never emerged under treatment of paroxetine and risperidone. We aimed to contribute this case because there is limited data in literature about this subject. As a result, adrenergic, cholinergic, serotonergic, dopaminergic and histaminergic pathways have role on control of micturition but it is not clear that on which pathway aripiprazole acts on urination. However there is no symptom of urinary retention after stopping aripiprazole and adding risperidone, shows that there is a different mechanism associated with voiding in this case. Additional studies need to be done to clarify the mechanism.