Yasemin Görgülü

Rapid antidepressant effects of sleep deprivation therapy correlates with serum BDNF changes in major depression

Recent reports have suggested that brain-derived neurotrophic factor (BDNF) levels are reduced in individuals suffering major depressive disorder and these levels normalize following antidepressant treatment. Various antidepressants and electroconvulsive therapy are shown to have a positive effect on brain-derived neurotrophic factor levels in depressive patients. The aim of this study was to assess the effect of total sleep deprivation therapy on BDNF levels in major depressive patients. Patients were assigned to two treatment groups which consisted of 22 patients in the sertraline group and 19 patients in the total sleep deprivation plus sertraline group. Patients in the sleep deprivation group were treated with three total sleep deprivations in the first week of their treatment and received sertraline. Patients in sertraline group received only sertraline. BDNF levels were measured in the two treatment groups at baseline, 7th, 14th, and 42nd days. Patients were also evaluated using the Hamilton Rating Scale for Depression (HAM-D). A control group, consisting of 33 healthy volunteers had total sleep deprivation, BDNF levels and depression measured at baseline and after the total sleep deprivation. Results showed that serum BDNF levels were significantly lower at baseline in both treatment groups compared to controls. Decreased levels of BDNF were also negatively correlated with HAM-D scores. First single sleep deprivation and a series of three sleep deprivations accelerated the treatment response that significantly decreased HAM-D scores and increased BDNF levels. Total sleep deprivation and sertraline therapy is introduced to correlate with the rapid treatment response and BDNF changes in this study.

Assessment of cytokine levels and hs-CRP in bipolar I disorder before and after treatment

We aimed to assess the relationship between cytokine levels and the severity of the manic period in medication free patients. 30 Medication free patients and 28 healthy subjects (HS) were recruited. Plasma levels of pro-inflammatory, anti-inflammatory, inflammatory cytokines, and hs-CRP levels were investigated upon hospital admission, after six weeks follow up in bipolar disease manic episode and the results were compared to HS. The severity of the manic episodes was assessed according to the Young mania rating scale. TNF-α, INF-γ, IL-6 and hs-CRP levels were significantly higher in patients with manic episode of bipolar I disorder before treatment than HS. After treatment the levels of TNF-α, INF-γ, IL-6 and hs-CRP were observed to be significantly decreased. There was no difference between the levels of anti-inflammatory cytokines in patients before or after treatment of bipolar disorder and HS. hs-CRP was observed to be the only parameter correlated with clinical response. The most significant outcome of this study is the correlation between clinical outcome and hs-CRP levels in treatment naive manic episode bipolar type I patients. hs-CRP is the most consistent indicator according to pro-inflammatory, inflammatory and anti-inflammatory cytokines, in predicting treatment outcomes.

Decreased interoceptive awareness in patients with substance use disorders

Abstract Introduction: The current study was prepared based on the assumption that awareness of the interoceptive processes may be disturbed in addicted individuals. Methods: The participants in the study included 84 abstinent male inpatients who were addicted to alcohol (n = 33), heroin (n = 29), or synthetic cannabinoids (n = 22) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), and 35 healthy male volunteers. Interoceptive awareness (IA) was measured using the heartbeat perception (HBP) task. Addiction severity was assessed using the addiction profile index (API). Alexithymia was assessed using the Toronto alexithymia scale (TAS-20). Results: Patients addicted to alcohol, heroin, or synthetic cannabinoids had similar IA, and their HBP scores were significantly lower than those of healthy control subjects. There was a significant negative correlation between HBP scores and TAS-20 subscores, thus indicating difficulties in identifying feelings. HBP scores were not significantly correlated with API scores. API scores were significantly correlated with total alexithymia scores and subscores, thus indicating difficulties in identifying and describing feelings. Discussion: As our main finding, a decrease in IA in addicted patients in comparison to healthy controls may provide support for the hypothesis that awareness of the interoceptive processes may be disturbed in addiction.

Peripheral blood mRNA expressions of stress biomarkers in manic episode and subsequent remission

Theoretical models of the neuroprogressive nature of bipolar disorder (BD) are based on the hypothesis that it is an accelerated aging disease, with the allostatic load playing a major role. Glucocorticoids, oxidative stress markers, inflammatory cytokines and neurotrophins play important roles in BD. The messenger ribonucleic acid (mRNA) expressions of brain-derived neurotrophic factor (BDNF), tissue plasminogen activator (tPA), glucocorticoid receptor (GR), heat shock protein 70 (HSP70), tumour necrosis factor-alpha (TNF-α) were examined in the peripheral blood of 20 adult male, drug-free BD patients during manic and remission periods and in 20 adult male, healthy controls. mRNA expression was measured using the quantitative real-time polymerase chain reaction (qRT-PCR). Compared to the controls, the expressions of BDNF and tPA mRNA were down-regulated in mania. In remission, BNDF and tPA mRNA levels increased, but they were still lower than those of the controls. Between mania and remission periods, only the change in mRNA levels of BDNF reached statistical significance. The results suggest that BDNF and tPA may be biomarkers of BD and that proteolytic conversion of BDNF may be important in the pathophysiology of BD. The change in BDNF levels between mania and remission could be adaptive and used to follow the progression of BD.

Serum agouti-related protein (AgRP) levels in bipolar disorder: Could AgRP be a state marker for mania?

Orexigenic and anorexigenic peptides, especially agouti-related protein (AgRP) and leptin, play important roles in the regulation of energy homeostasis in bipolar disorder. AgRP regulates energy metabolism by increasing appetite and decreasing energy expenditure. The resting energy expenditures of patients with manic bipolar disorder are higher than those of controls. Due to the effects of AgRP on energy expenditure and the increased physical activity of manic patients, we hypothesised that serum AgRP levels may be lower in manic patients than in euthymic patients and controls. There was a total of 112 participants, including 47 patients in the manic group, 35 patients in the euthymic group and 30 healthy controls. For this study, serum AgRP, leptin, cholesterol, and cortisol levels were measured and compared between the groups. The serum AgRP, leptin, and cholesterol levels were significantly different between the groups. The serum AgRP levels of manic group were significantly lower than those of euthymic and control groups. The lower serum AgRP levels of manic patients could be indicators of impaired energy homeostasis during manic episodes. Since the serum AgRP levels of manic patients are lower than those of euthymic patients and controls, AgRP could be a state marker for manic episodes.

Effects of Selective Serotonin Reuptake Inhibitors on Macular Ganglion Cell Complex Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness

ABSTRACT Purpose: To evaluate macular ganglion cell complex (GCC) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in patients treated with SSRIs. Methods: The present study included 62 eyes of 31 patients who were using SSRIs and 60 eyes of 30 healthy, age- and gender-matched control subjects. All patients underwent a full ophthalmological examination in which macular thickness, GCC thickness, and peripapillary RNFL thickness were measured using optical coherence tomography (OCT). The Mann–Whitney U test was used to compare the patients’ group with the age- and gender-matched control group. Pearson correlation analyses were also performed to assess the relationships between macular thickness, GCC thickness, RNFL thickness, and the duration of SSRI usage. Results: The mean duration of SSRI usage was 29.96 ± 27.19 (range 6–120) months. The foveal thickness was 253.48 ± 22.77µm in the patients’ group and 266.60 ± 20.64 µm in the control group; the difference between the groups was statistically significant. In addition, the perifoveal GCC thickness in the inferonasal and inferotemporal quadrant were significantly smaller thinner in the patient group (Mann–Whitney U test, p = 0.021and p = 0.013, respectively). Conclusions: Our results suggest a relation between SSRIs and decreased retinal GCC thickness and RNFL thickness. Future long-term prospective studies should elucidate the actual effect of SSRIs on GCC and RNFL thickness.

Evaluation of phosphatidylethanol by ELISA for detection of excessive alcohol use compared with traditional biomarkers: a case-control study

ABSTRACT Objective: The highly sensitive chromatographic methods for quantifying phosphatidylethanol (PEth) require high levels of expertice and expensive instrumentation. Enzyme-linked immunosorbent assay (ELISA) kits have been developed for research purposes, but the implementation of PEth immunoassays to screen alcohol consumption has not been applied to the analysis of clinical samples. Our aim was to examine the ELISA method for PEth analysis in clinical samples. Methods: We examined the alterations of the PEth serum levels of 22 male inpatients diagnosed with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, during alcohol withdrawal (at days 1, 7, and 14) compared to 32 healthy controls using ELISA. All patients were admitted for detoxification treatment at the Alcohol and Substance Addiction Treatment and Rehabilitation Center, Trakya University School of Medicine, Edirne, Turkey. Control subjects were assessed with an initial clinical interview and screened with the Alcohol Use Disorder Identification Test (AUDIT), and they included 16 nondrinkers (AUDIT score = 0) and 16 social drinkers (AUDIT score < 8). We examined the diagnostic accuracy of PEth compared to the traditional biomarkers according to the receiver operating characteristic curve analysis. Results: The patients undergoing detoxification had higher baseline PEth levels than the non-drinkers and social drinkers; the difference between groups showed a marginal trend towards significance (p = 0.052). PEth was correlated with the self-reported drinking amount in the past month and AUDIT scores, and the correlations showed marginal trends towards significance (rs = 0.269, p = 0.049; and rs = 0.266, p = 0.052; respectively). The PEth levels were statistically significantly correlated with gamma-glutamyl transferase (GGT) (rs = 0.355, p = 0.010), the correlations with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) trended towards statistical significance (rs = 0.230, p = 0.095; and rs = 0.261, p = 0.056, respectively), and PEth was not statistically significantly correlated with mean corpuscular volume (MCV) (rs = 0.100, p = 0.478). PEth levels decreased statistically significantly during alcohol withdrawal (p = 0.002). PEth levels of the nondrinkers and social drinkers did not differ statistically significantly (p = 1.000). The area under the curve (AUC) for PEth measured by ELISA was statistically significantly higher than 0.5 (AUC = 0.691, p = 0.024), but PEth had poorer diagnostic efficacy than GGT (AUC = 0.933, p < 0.001), AST (AUC = 0.931, p < 0.001), MCV (AUC = 0.803, p < 0.001), and ALT (AUC = 0.789, p < 0.01). Conclusions: The AUC of 0.69 shows that the diagnostic accuracy of the assay was poor, regardless of a statistical comparison to 0.5. The use of serum might have led to low concentrations that have not differed much between heavy drinkers and social drinkers or abstainers. Whole blood ELISA implementation for the quantification of PEth may increase its diagnostic efficacy.

Psychiatric Disorders in Medically Ill Inpatients Referred for Consultation in a University Hospital

Objective: The distribution of psychiatric consultations in a university hospital according to the socio-demographical attributes of the patients, the clinics from which the consultations were asked, the psychiatric diseases that were diagnosed and the psychiatric treatments were analyzed in this trial. Method:The consultation forms of the patients aged 18 or more that were being treated in hospital from 1st Janurary to 31th December, 2011 and consulted to the psychiatry clinic were analyzed retrospectively. The diagnoses were made according to DSMIV-TR diagnostic criteria. The statistical analysis were done with SPSS 20.0 and the results were given as percentage values. Results: 422 female (54.5%), 353 male (45.5%) totally 755 patients who were under treatment in hospital except psychiatry clinic and conculted to psychiatry were included in this trial. The mean age of the patients were 50.4±15.5. The most common consulting clinics were internal medicine (%35.2), pysical therapy and rehabilitation (%15.2) and general surgery (%9.7). The consulting reasons were depressive complaints (%24.5), psychiatric assesment asking without any reason (%24.3), agitation (%13.4) and as a result of prior psychiatric illness history (%10.1). Pyschiatric illnesses that were diagnosed were adjustment disorder (%19), delirium (%18.1) and depression (%17.4). There were no psychological disease that were providing diagnostic criteria in 23.7% of the patients. 35.2% of the patients were advised treatment with antidepressants, 22.6% with antipsychotics, 9% with benzodiazepines, 1.2% with mood stabilizers but 32 % were not advised any medical treatment. Conclusion: The results of our investigation emphasizes the importance of consultation liaison psychiatry unit. By collaboration with other clinics, global assesment but not only physical wellness also psychological assesment of the patients will be evaluated.

Alcohol and Psychoactive Substance Use among University Students in Edirne and Related Parameters

INTRODUCTION Alcohol and psychoactive substance use and their effects are an important issue among adolescents and young adults. Different results have been reported about the frequency of alcohol and psychoactive substance use among university students in studies conducted both in Turkey and in different places worldwide. METHODS The frequency of alcohol and psychoactive substance use among Trakya University students (n=1385) and the related parameters were studied cross-sectionally using a self-reporting questionnaire. RESULTS Alcohol was the most common substance used (30%), followed by tobacco (29.9%) and marijuana (3.1%). The frequency of alcohol and psychoactive substance use was found to be higher among males with higher amounts of pocket money, whose parents experienced more conflict in their relationship, and who belong to families with a higher education and income level. CONCLUSION The frequency of alcohol and psychoactive substance use among Trakya University students was found to be lower than other regions in Turkey and particularly lower than the levels reported in studies conducted in other countries.

Substance Use and Parent Characteristics Among High School Students: Edirne Sample in Turkey

ABSTRACT The current study on substance use and family characteristics of adolescents is a part of the extensive research on substance use characteristics among high school students in Edirne, Turkey. This cross-sectional study was conducted with 8,483 high school students within the 2010–2011 academic year. Self-administered questionnaires were completed anonymously by the participants. The lifetime prevalence of alcohol use was 24.6% and tobacco use was 21.4%. The most commonly used illicit substance was cannabis (1%), followed by inhalants (0.5%) and ecstasy (0.4%). The use of alcohol, tobacco, and nearly all the illegal substances was significantly higher among males compared to females. The rates of lifetime substance use varied by family-related factors such as family structure, perceived parental attitudes and intrafamilial relationships, parental socioeconomic status, and parental substance use. The limitations and implications of these findings are discussed.