Turan Ertan

Relationship between age and subtypes of psychotic symptoms in Parkinson's disease

ObjectivePsychotic symptoms (PS) in Parkinsons disease (PD) usually develop as a side effect of the dopaminergic therapy and consist of hallucinations and delusions. We observed that PD patients who developed delusions tend to be younger than those with hallucinations and we aimed to investigate the validity of this observation.MethodsThe medical records of 127 PD patients with PS were reviewed and 76 patients who were on treatment with dopamine agonists with or without levodopa at the time of developing PS were included. Patients were stratified into 3 groups according to the subtypes of PS: patients with solely hallucinations (n = 46), solely delusions (n = 18), and both types (n = 12). The groups were compared with respect to the age-at-onset of PD and PS, duration of PD, Activities of Daily Living (ADL) and motor subscale scores of Unified PD Rating Scale (UPDRS), and levodopa equivalent dose of the dopaminergic agents administered at the time of PS onset.ResultsThe mean age-atonset of PD and PS was significantly younger (p = 0.0001) in patients with delusions (49 and 55.9 years) than those with hallucinations (61.9 and 68.9 years). The same parameters were also significantly different (p = 0.002 and p = 0.001, respectively) between the groups of patients with concurrent delusions and hallucinations (51.7 and 57.2 years) and those with only hallucinations. ADL and motor subscale scores were higher in patients with hallucinations (p = 0.016 and p = 0.013) compared with those noted in patients with delusions despite similar disease duration. The mean levodopa equivalent doses of the dopaminergic agents administered at the time of onset of PS did not differ between the groups.ConclusionThis study supported an association of delusions with younger onset of both PD and psychosis as compared with hallucinations. However, additional factors related to this association remain to be elucidated.

Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression

Objective: The aim of this study was to assess the validity and reliability of the 30-item Geriatric Depression Scale (GDS) as a screening tool for minor depression in poststroke patients. Method : Literate patients older than 18 years of age, diagnosed to have stroke, were eligible for the study. Standardized Mini Mental Status Examination (S-MMSE) and GDS were applied to all patients. The GDS was readministered 7 days later for retest reliability. Results: A total of 85 participants—49 nondepressed and 36 with minor depression—were eligible for the study. Cronbachs alpha coefficient was .89 in internal consistency analysis. The GDS scores were significantly higher (p < .001) in the depressed participants reflecting a high discriminant validity. The highest sum of sensitivity and specificity values of 1.44 (sensitivity = .69, specificity = .75) and 1.45 (sensitivity = .66, specificity = .79) were obtained for cutoff scores of 10/11 and 11/12, respectively. The area under receiver operating characteristics curve was .82. The test–retest reliability analysis revealed a high Pearson correlation coefficient (r = .75). Conclusion: Our findings suggest that the 30-item GDS has high discriminant validity, internal consistency, and test–retest reliability and reasonably useful cutoff scores; thus it can be used as a screening tool for minor depression in the poststroke population.

Clinical characteristics of 49 patients with psychogenic movement disorders in a tertiary clinic in Turkey.

Patients admitted to movement disorders outpatient unit at a university hospital between January 2002 and June 2007 were screened for psychogenic movement disorders (PMDs). Out of 1,743 patients, 49 patients (2.8%), including four children, were diagnosed to have PMDs. Women to men ratio was 34/15. The mean age and the age‐at‐onset were 41 ± 17 years and 36 ± 15 years in the adult group, and 10 ± 2 and 9 ± 2 years in children. Among the whole group, 44% had tremor, 24% dystonia, 12% pure gait disorders, 8% parkinsonism, 6% chorea‐ballism, and 4% tic disorder. PMD developed acutely in 85% of patients, and distractibility was observed in 83%. Of the patients, 81% met the criteria for clinically established PMD, whereas 16% for documented and 2% for probable PMD. Although our data was obtained from a different culture, our results showed that hospital‐based frequency and phenomenological features between our PMD group and previously reported ones are similar.

Anxiety and depression in COPD patients and correlation with sputum and BAL cytology.

Background and aimsAnxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD). The degree of lung function may not explain anxiety and depression. The aim of our study was to assess the psychological aspects of COPD, to test the BODE index (a composite score of body mass, obstruction, dyspnea and exercise capacity), and to evaluate the association between atypical cytologic findings of sputum, bronchoalveolar lavage (BAL) and the pyschological components of the disease.MethodsCOPD was classsified according to the GOLD stages based on forced expiratory volume in 1 second (FEV1) in 60 stable patients. The BODE index was calculated for grading COPD. The Hospital anxiety and depression (HAD) scale was used to appraise the anxiety and depression symptoms. Cytologic examination of sputum and BAL samples were performed in each patient. The cytologic findings were classified as normal, mild, moderate or severe atypia.ResultsThe overall prevalance of anxiety and depression symptoms was 41.7% and 46.7% respectively. The prevalance of these symptoms increased with increasing BODE stages and correlated well with the severity of atypical BAL cytology results (p < 0.001). Dyspnea and reduced exercise capacity were the predominant mechanisms leading to anxiety and depression symptoms associated with COPD.ConclusionsWe conclude that the BODE index is superior to GOLD stratification for explaining anxiety and depression symptoms in COPD. BAL cytologic findings, which reflect the distal parenchymal lung structure, correlated significantly with the presence of the anxiety and depression symptoms.RiassuntoRazionale e scopoAnsietà e depressione sono frequenti nel pazienti con broncopneumopatia cronica ostruttiva (BPCO). Il semplice quadro funzionale può non spiegare adeguatamente ansia e depressione. Scopo del nostro studio era valutare gli aspetti psicologici della BPCO, testare il BODE index (un punteggio composito che tiene conto di massa corporea, ostruzione, dispnea e capacità di esercizio) e valutare l’associazione tra i rilievi patologici nella citologia di espettorato e BAL con la componente psicologica della malattia.MetodiLa BPCO è stata classificata secondo la stadiazione GOLD basata sul volume espiratorio forzato in un secondo (FEV1) in 60 pazienti stabili. L’indice BODE è stato calcolato per dare una stima di gravità della BPCO. Per valutare i sintomi di ansia e depressione è stata utilizzata la scala Hospital anxiety and depression (HAD). In ogni paziente è stata effettuata la valutazione della citologia dell’espettorato e del BAL. I risultati della citologia sono stati classificati come normali o con atipia lieve, moderata o grave.RisultatiLa prevalenza complessiva dei sintomi di ansietà e depressione era rispettivamente del 41,7% e 46,7%. La prevalenza di questi sintomi aumentava all’incremento dello stadio BODE e correlava con la gravità delle atipie nel reperto citologico del BAL (p < 0,001). I meccanismi prevalenti che inducevano ansietà e depressione in associazione con la BPCO erano la dispnea e la ridotta capacità di esercizio fisico.ConclusioniConcludiamo che l’indice BODE è più efficace della stratificazione GOLD nello spiegare i sintomi di depressione e ansia nei BPCO. I risultati della citologia sul BAL, che riflettono la struttura del polmone profondo, correlano significativamente con la presenza dei sintomi di ansietà e depressione.

Case series with late-onset psychosis hospitalized in a geriatric psychiatry unit in Turkey: experience in 9 years.

In this article we report the first series of Turkish inpatients with late-onset psychosis, and describe our 9-year experience at the only inpatient geriatric psychiatry department in Turkey. Among 420 patients hospitalized between 1993 and 2002, 27 were psychotic. In this group, eight patients were diagnosed as having late-onset schizophrenia (LOS) and six very-late-onset schizophrenia-like psychosis (VLOSLP). Five patients had early-onset schizophrenia and eight had delusional disorder. Females were more frequently seen in the group with LOS and the group with VLOSLP. Except for one patient with LOS, all patients with VLOSLP and LOS had paranoid psychosis. Nihilistic delusions, delusions of poverty or guilt, thought withdrawal, thought insertion, and thought broadcasting were not seen in any of the patients. Additionally, none of the LOS or VLOSLP patients showed erotomanic delusions. Grandiose and mystic delusions were not seen in those with VLOSLP. Treatment results and antipsychotic dosages at discharge were similar to those in previous reports from other cultures.

Interleukin-1α –889 C/T Polymorphism in Turkish Patients with Late-Onset Alzheimer’s Disease

Background/Aims: The polymorphism (rs1800587) in the 5′-flanking regulatory region at –889 of the interleukin-1α gene has been shown to be associated with inflammatory diseases and Alzheimer’s disease (AD). The aim of the current study is to determine whether there is an association between the promoter region polymorphism of the interleukin-1α gene and late-onset AD in a cohort of Turkish patients. Methods: One hundred and four subjects with dementia of the Alzheimer type and 103 age-matched controls were genotyped according to the PCR with confronting two-pair primers method. Results: Although the distribution of genotypes did not significantly differ (p = 0.107), the difference between allelic frequency was nearly significant according to a χ2 test (p = 0.05) when the controls and patients were compared. Conclusion: Our results showed that there is no association between the –889 C/T transition on the interleukin-1α gene and late-onset AD in the Turkish population.

The Association Between Clusterin and APOE Polymorphisms and Late-Onset Alzheimer Disease in a Turkish Cohort

Previous studies have demonstrated that clusterin (CLU), which is also known as apolipoprotein J, is involved in the pathogenesis of Alzheimer disease (AD). In this study, we investigated the association between rs2279590, rs11136000, and rs9331888 single-nucleotide polymorphisms (SNPs) in CLU and apolipoprotein E (APOE) genotypes in a cohort of Turkish patients with late-onset AD (LOAD). There were 183 patients with LOAD and 154 healthy controls included in the study. The CLU and APOE polymorphisms were genotyped using the LightSNiP assay. The “GG” genotype of rs9331888 was significantly more frequent in patients with LOAD. The “CC” genotype of the SNP was significantly more frequent in controls. The rs9331888 “GG” genotype in patients and the “CC” genotype in controls were significantly higher in non-∊4 allele carriers of APOE. The haplotype analysis showed the CLU “GCG” haplotype was a risk haplotype. Our findings indicate the rs9331888 SNP of CLU is associated with LOAD independent of APOE.

Presenilin-1 Gene Intronic Polymorphism and Late-onset Alzheimer's Disease

Presenilin-1 is known to contribute to the pathogenesis of Alzheimers disease. The association of an intronic polymorphism (rs165932) of the presenilin-1 gene with late-onset Alzheimers disease has been documented. However, contradicting results have been shown in different populations. The aim of the current study is to determine whether there is an association between the intronic polymorphism of the presenilin-1 gene and late-onset Alzheimers disease in a cohort of Turkish patients. One hundred and seven participants with dementia of the Alzheimer type and 106 age-matched controls were genotyped according to BamH I restriction site in intron 8 of the presenilin-1 gene. The distribution of genotypes and alleles did not significantly differ according to χ 2 test (P = .52, P = .32, respectively), when the control and patients were compared. Consequently, our results showed that the 1/1 genotype does not increase the risk of developing late-onset Alzheimers disease in the Turkish population.

Thyrotoxic psychosis in an elderly woman and haloperidol use: a case report.

Thyrotoxic patients may occasionally present with affective disorders. Here, we discuss a case of a 61‐year‐old woman with misidentification and persecutory delusions, olfactory hallucinations, and apathy associated with thyrotoxicosis. After definitive antithyroid and antipsychotic agent haloperidol treatments, the patient was released within 4 weeks. Thyrotoxic psychosis with apathy is a rare entity that can be misdiagnosed as affective psychosis. Haloperidol may be an alternative treatment in resolving psychotic features beside the treatment of hyperthyroid state.

Pure gait disturbance displayed by malingerers: Case report of two patients

Although not considered as a mental illness, malingering is efined among ‘code V’ in the fourth edition of the Diagnostic nd Statistical Manual of Mental Disorders (DSM-IV) as one of he “Other Conditions” that require medical attention [1]. The ssential feature of the malingering is the intentional production f false or grossly exaggerated physical or psychological sympoms, motivated by external incentives such as avoiding military uty, avoiding work, obtaining financial compensation, evading riminal prosecution, or obtaining drugs. Malingering is not conidered as a form of psychopathology, but could also emerge in the ontext of mental or personality disorders. The differential diagnois of malingering from conversion disorders, factitious disorder, ypochondriasis and somatoform disorders requires careful examnation by an experienced psychiatrist. Phenomenologically, they could mimic the full spectrum f almost any kind of organic disorders, including movement isorders. Abnormal gait disorders of psychogenic origin are charcterized by exaggerated effort, slowness, unusual uneconomic ostures, knee buckling, and near falling [2,3]. Psychogenic gait disrders (PGD) account for 1.5% to 4.5% of all patients admitted to a ovement disorder clinics [4–7]. Psychogenic disorders are classied as the somatoform disorders, where it is assumed that patients re not intentionally or consciously producing their symptoms or igns. In contrast, other conditions such as factitious disorder and