Vahap Ozan Kotan

Effects of long-term antidepressant treatment on oxidative status in major depressive disorder: A 24-week follow-up study

PURPOSEnMajor depressive disorder (MDD) is a devastating disease that afflicts large populations and has also been accepted to be an independent risk factor for cardiovascular disease (CVD). Oxidative stress seems to play an essential role in the relationship of MDD and CVD. We aimed to determine the level of oxidative stress in patients with MDD and to investigate the effects of long-term antidepressant (AD) treatment on the oxidative-antioxidative system parameters and CVD risk factors.nnnMETHODnFifty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MDD and 44 healthy control subjects were included in the study. Control visits of the patients were repeated 6weeks, 12weeks and 24weeks after beginning of the AD treatment. Lipid profiles, oxidation and oxidizability of apolipoprotein B-containing lipoproteins (expressed as apo B-b-MDA and apo B-Δ-MDA, respectively), levels of plasma malondialdehyde (p-MDA), total antioxidative capacity (TAOC), antioxidant molecules and antioxidant enzyme activities including paraoxonase/arylesterase, red blood cell superoxide dismutase (RBC-SOD) and glutathione peroxidase were determined during 24-week of follow-up period.nnnRESULTSnAccording to the results of the study, p-MDA, apo B-b-MDA and RBC-SOD activity were increased and arylesterase activity was decreased in MDD patients. Body mass index (BMI), vitamin A and total cholesterol levels in MDD patients increased after 24-weeks of AD treatment. RBC-SOD activity, TAOC, p-MDA and apo B-b-MDA levels were decreased; paraoxonase/arylesterase activities and apo B-Δ-MDA were increased at the end of 24th week.nnnCONCLUSIONnOxidative stress, demonstrated in MDD patients, was partly improved during 24weeks of AD treatment. Increase in paraoxonase/arylesterase activities and decrease in p-MDA and apo B-b-MDA levels after 24weeks seem to be beneficial for reduction of CVD risk in MDD patients. However increased BMI and apo B-Δ-MDA levels are negative cardiovascular effects of long-term AD treatment.

Thiol/disulphide homeostasis in bipolar disorder

Bipolar disorder (BD) patients have increased oxidative stress, which can disturb thiol/disulphide homeostasis, causing disulphide formation. The aim of the study is to investigate dynamic thiol/disulphide (SH/SS) homeostasis in BD patients, which is a novel evaluation method of oxidative status. Ninety-four BD patients (50 in the manic episode and 44 in remission) and 44 healthy controls were included in the study. Blood serum native thiol (SH) and total thiol (ToSH) concentrations were measured in a paired test. The half value of the difference between native thiol and total thiol concentrations was calculated as the disulphide (SS) bond amount. Serum native thiol levels of the mania group were found to be lower than the remission and the control groups. There was a significant difference between the remission group and the control group in terms of native thiol. Serum total thiol level was lower in mania group than the control group. Detection of oxidative molecules for BD could be helpful, especially in treatment, follow-up periods and reducing morbidity. The results of our study besides the data available in the literature support that thiol and disulphide levels are useful markers for BD and promising therapeutic targets in terms of future pharmacological modulation.

Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay

BackgroundCognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales ‘Beliefs About Substance Use’(BSU) and ‘Craving Beliefs Questionnaire’(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment.MethodsOne hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores.ResultsCronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (pu2009<u20090.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (pu2009<u20090.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (pu2009<u20090.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (pu2009<u20090.003).ConclusionsCraving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients’ beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction.

The relationship between internalized stigma and treatment motivation, perceived social support, depression and anxiety levels in opioid use disorder

ABSTRACT OBJECTIVE: This study aims to examine how internalized stigma differs in opioid use disorder (OUD) based on sociodemographic and clinical variables, and to what extent internalized stigma is related to treatment motivation, perceived social support, depression, and anxiety levels. METHODS: One hundred forty-five individuals with OUD included. Sociodemographic and clinical data form, the Internalized Stigma of Mental Illness Scale (ISMI), Treatment Motivation Questionnaire (TMQ), Multidimensional Scale of Perceived Social Support, the Beck Depression Inventory, and the Beck Anxiety Inventory were utilized in the study to collect data. Bivariate and partial correlation coefficients between variables were computed. ISMI and TMQ scores were compared between patients with depressive symptoms and patients without depressive symptoms by using t-test and Mann Whitney U test. RESULTS: Internalized stigma was high among male patients with heroin use disorder. There was a positive correlation between internalized stigma score and treatment motivation, depression, and anxiety levels. On the other hand, there was a negative correlation between internalized stigma score and multidimensional perceived social support. CONCLUSION: Internalized stigma occupies an important place in the treatment of OUD, which occurs with frequent relapses and which is hard to treat. Not only application for treatment but also adherence to treatment and treatment motivation at maintenance phase bestow a complicated relationship with depression and anxiety. In the struggle against internalized stigma, it plays a vital role to mobilize people’s social support systems, to educate families on the issue and to get in touch with support units exclusive to heroin users.

The severity of dissociative symptoms among patients with cannabis and synthetic cannabinoid use disorder: association with substance use characteristics and suicide

ABSTRACT OBJECTIVE: Cannabis (C) and synthetic cannabinoids (SCs) are commonly used substances. Pharmacodynamic and pharmacokinetic differences predict that SCs involve a greater risk of dependence than C. Dissociative symptoms and suicidality are also frequent in treatment-seeking substance users, however, there is not enough data about the dissociative effects of C and SCs. The present study aimed to examine SC users in terms of demographic features and severity of dissociative symptoms in comparison to C users. It was also aimed to explore the relationships between dissociation and suicide attempts. METHODS: The study was performed at the Alcohol and Substance Research, Treatment, and Training Centre of Ankara Numune Training and Research Hospital, Turkey. 84 patients with C or SC use disorder included in the study and all the participants were administered a sociodemographic data form assessing also substance use features and suicide attempts and Dissociative Experiences Scale (DES). The patients were separated into three groups as only C users (CU), only SC users (SCU) and both C and SC users (C&SCU) and also categorized as DES score <30 as the low dissociation level and DES score of ≥30 as the high dissociation level. Correlations between variables were tested using Spearman correlation coefficients and the predictors of high dissociation level were evaluated using logistic regression analysis. A value of pu2009<u20090.05 was considered statistically significant. RESULTS: DES mean score was 28.82 in all participants. Dissociation levels (pu2009=u20090.058) and high dissociator rates (pu2009=u20090.443) were similar among CU, SCU, and C&SCU groups. Age at onset of substance use was negatively correlated with the severity of dissociative symptoms (ru2009=u2009−0.22, pu2009=u20090.042). DES mean score of patients with a history of suicide attempt was 40.51, significantly higher than that of those without (23.47). Age at onset of substance use, lifetime years of substance use, type of substance used (C, SC, and C&SC usage) were not significant predictors, only the history of suicide attempt was the significant predictor of high dissociation level (Bu2009=u20091.886, S.E.u2009=u20090.542, Waldu2009=u200912.104, dfu2009=u20091, pu2009=u20090.001, OR = 6.596, 95% CIu2009=u20092.279-19.089). CONCLUSIONS: The findings support that dissociation levels are high in C and SC users as in other substance users, however, dissociative effects of C and SCs do not differ from each other. Besides the dissociative effects of C and SC use, there is also a significant effect of the suicide attempt history on the severity of dissociative symptoms. Although the relationship between dissociation and type of substance used is not clear, there is an association between dissociation and the history of suicide attempt. C and SC users are also concerned with dissociative symptoms that should be considered by the clinician since it affects the treatment modality and treatment response.

Serum glial cell line-derived neurotrophic factor levels and impulsivity in heroin addiction: a cross-sectional, case-control study of 129 heroin addicts

ABSTRACT OBJECTIVE Glial cell line-derived neurotrophic factor (GDNF), being a protective of dopaminergic neurons, is reported to modulate addictive behaviours and have a role as a negative regulator for biochemical and behavioural adaptations to drug abuse. We aimed to reveal impulsivity and serum GDNF levels in patients with heroin addiction and investigate their relationships in order to contribute to the understanding of behavioural aspects and biological mechanisms in heroin addiction via this study. METHODS This study was performed at the Department of Psychiatry of Ankara Numune Training and Research Hospital, Turkey. We recruited 129 heroin-dependent patients and 90 age, sex, and smoking-matched healthy controls with no major psychopathology. Barratt Impulsivity Scale-11, Hospital Anxiety and Depression Scale (HADS) and sociodemographic data form were applied to all participants. Laboratory analysis for serum GDNF levels was performed for each participant’s blood sample. RESULTS Total impulsivity scores and scores of Attentional Impulsivity, Motor Impulsivity, and Unplanned Impulsivity subscales were all higher in heroin addicts compared to the controls. Heroin addicts had also lower serum GDNF levels and lower GDNF levels were associated with high impulsivity and high HADS scores in heroin addicts. CONCLUSION Decrement in GDNF levels in heroin addiction seems as to be an important data which could be associated with impulsivity, anxiety, and depressive symptoms. GDNF could find a prominent place among the target molecules in the treatment of heroin addiction.

Reversible cycloplegia caused by duloxetine: a case report

ABSTRACT A Duloxetine is a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine (SNRI) that has previously been shown to be effective in the treatment of major depressive disorder (MDD), generalized anxiety disorder, and diabetic peripheral neuropathic pain (DPNP). Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Here, we present a reversible cycloplegia case caused by duloxetine use. The patient was a 24 years-old woman with MDD diagnosis. Patient had somatic symptoms like fatigue, myalgia, and headache, besides her depressive symptoms for the last two months. Escitalopram and sertraline were used for her MDD before and she had to quit both owing to side effects such as nausea and drowsiness. Duloxetine 30mg/day treatment was started in our outpatient clinic. In her first follow-up exam, she reported light sensitivity and increased visual impairment. The visual impairment led dizziness and an increase in headache. She was consulted to ophthalmology unit of our hospital and cycloplegia was detected in her eye examination. Duloxetine was stopped in the ninth day of treatment but cycloplegia negatively affected the patients daily life for almost 4 weeks and impaired her functionality. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects. Eye pain, changes in vision and swelling or redness in or around the eye are mentioned as possible visual side effects in the medication of duloxetine. The ocular and visual side effects from a patients systemic medication can range from mild to severe. These side effects may or may not be serious enough to warrant discontinuing treatment. Cycloplegia seems as a rare adverse effect in antidepressant treatment and may take a long time to wash out. Recognition of ocular and visual side effects is important to prevent and minimize serious complications. In such visual disturbances, eye examination of the patient should be performed and the responsible drug should be discontinued as early as possible.

Association of Domestic Violence Against Women With Sociodemographic Factors, Clinical Features, and Dissociative Symptoms in Patients Who Receive Services From Psychiatric Outpatient Units in Turkey:

Domestic violence (DV) against women is a serious problem with its negative effects on all family members and the society. Women exposed to DV not only have physical but also psychological damage. This study investigates prevalence of DV and its relations with some descriptive and clinical features in a psychiatric outpatient population in Turkey. A total of 277 female outpatients were included in the study. After a semistructured clinical interview, they were assessed by sociodemographic data form, DV questionnaire, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Prevalence of exposure to DV by intimate partner is found to be 58.8% (n = 163). The current study provided strong evidence that occupation status of the woman, education level of the partner, and family type are predictors of DV. Another predictor of DV exists where the child is battered by either parent. Prevalence of depression, conversion disorder, and other somatoform disorders are higher in women exposed to DV. These women also have higher scores from HDRS, HARS, DES, and SDQ compared with female patients who have not experienced DV (p < .001). Number of women scoring above cutoff levels for DES and SDQ were significantly higher in women exposed to DV (p < .001).

Assessment of Irisin, Adiponectin and Leptin Levels in Patients with Schizophrenia

BACKGROUNDnThe patients with schizophrenia are at increased risk for problems regarding metabolic parameters due to their lifestyle and antipsychotic treatment.nnnOBJECTIVEnIn this study, we aimed to evaluate the levels of adiponectin, leptin, irisin in patients with schizophrenia who were nondiabetic, nonobese and under antipsychotic treatment.nnnMETHODn5 ml sample of venous blood was collected from each participant. Blood cells were separated from the serum. The serum samples were stored in a -80°C freezer. Biochemical analyses were performed on these samples. Adiponectin, leptin and irisin levels were measured by Enzyme Linked Immunosorbent Assay method.nnnRESULTSnThe study included 88 subjects. Of them, 44 were patients with schizophrenia and 44 were healthy controls. There were no statistically significant results when the c-reactive protein, adiponectin, leptin and irisin levels were compared between the schizophrenia and the control group (p>0.05).nnnCONCLUSIONnIn our study, adiponectin, leptin and irisin levels in patients with schizophrenia did not present a statistically significant difference from healthy controls. Therefore, there is a need for studies including more participants to investigate the level of irisin in patients with schizophrenia.

Thiol/disulphide homeostasis in men with heroin addiction

Thiol/disulphide homeostasis in men with heroin addiction Objective: Heroin addicts have increased oxidative stress which can disturb thiol/disulfide (SH/SS) homeostasis, causing disulfide formation. No study has determined the serum thiol amount and blood disulfide amount in heroin addicts. The aim of the study was to investigate dynamic SH/SS homeostasis in heroin addicts. Methods: Serum SH/SS statuses of 31 heroin addicts and 31 healthy controls were compared to determine the changes in SH/SS homeostasis in heroin addicts. Blood serum native thiol and total thiol (ToSH) levels were measured and the disulfide bond amount was calculated as the half value of the difference between native thiol and ToSH levels. For comparison t-test was used. Results: SH and ToSH levels were significantly lower (p<0.001 for both) in heroin addicts than in the healthy group whereas disulfide levels were significantly higher (p<0.001). Heroin addicts had significantly higher SS/ToSH and SS/SH ratios and significantly lower SH/ToSH ratios than healthy individuals. Conclusion: The results showed that SH and ToSH levels were decreased in heroin addicts and SH/SS homeostasis was also disturbed with a shift to the disulfide bond formation side. Results of this study could contribute to the knowledge about pathogenesis of heroin addiction and also to its management. We suggest that replacement of the thiol gap and reduction of excess SS might have positive effects in treatment results.