Hippocampus and amygdala volumes are reduced in patients with schizoaffective disorder.

We aimed to examine the hippocampus and amygdala volumes in patients with schizoaffective disorder with the notion that schizoaffective disorder has strong resemblance of clinical presentation with schizophrenia and bipolar disorder and that there have been studies on regions of interest volumes in patients with schizophrenia and bipolar disorder but not in patients with schizoaffective disorder. Eighteen patients with schizoaffective disorder and nineteen healthy controls were included into the study. Hippocampus and amygdala volumes were examined by using the MRI. Both hippocampus and amygdala volumes were statistically significantly reduced in patients with schizoaffective disorder compared to those of the healthy control comparisons (p<0.001 for the hippocampus and p<0.001 for the amygdala). In summary, our findings of the present study suggest that patients with schizoaffective disorder seem to have smaller volumes of the hippocampus and amygdala regions and that our results were in accordance with those obtained both in patients with schizophrenia and bipolar disorder, considering that schizoaffective disorder might have neuroanatomic similarities with both schizophrenia and bipolar disorder. Beacuse of some limitations aforementioned especially age, it is required to replicate our present results in this patient group.

Pituitary volumes in patients with adjustment disorder.

The pituitary gland plays an important role in the stress response mechanism. Given the direct link between adjustment disorder and stress, we hypothesized that there might be changes in the pituitary gland in these patients. The study comprised a patient group of 19 individuals with adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, and 18 healthy controls. The mean pituitary gland volumes of the patient group were not statistically significantly different from those of the healthy control group (80.81 ± 1.82 mm3 in patients with adjustment disorder vs. 81.10 ± 7.04 mm3 in healthy controls, with a statistically nonsignificant difference of P > 0.05). This finding is contrary to our previous findings in anxiety-related disorders. In this regard, adjustment disorder is not similar to anxiety-related disorders in terms of pituitary gland volumes. We should also clearly state that our study is a pioneering study and that studies with large samples are needed to support our findings. The limitations of our study can be attributed to the small sample size, the utilization of a cross-sectional design, and the inclusion of patients using psychotropic drugs.

Cortical Thickness of the Orbitofrontal Cortex in Patients with Alcohol Use Disorder.

AIMS: In the present study, it was hypothesised that compared to healthy control subjects, significant differences in the cortical thickness of the orbitofrontal cortex (OFC) region of the brain, which is relevant to both impulsivity and decision making, would be identified. METHODS: The subject groups included in the study were composed of 15 individuals who met the criteria for alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 (SCID), and were admitted to the Firat University School of Medicine Department of Psychiatry or were hospitalised, and 17 healthy control comparisons were made. The volumes of and cortical thickness of the OFC were measured in the subjects. RESULTS: It was found that patients with alcohol use disorder had reduced volumes of the OFC bilaterally and a thinner cortical thickness of the same region bilaterally compared to those of the healthy control comparisons. CONCLUSIONS: Consequently, it is suggested that the OFC region of the brain appears to be statistically significantly smaller in patients with alcohol use disorder, both in terms of cortical thickness and volume, compared to healthy controls. Future research should focus on the status of these relationships longitudinally and should assess the causality of the association with the treatment response.

Pituitary Volume in Individuals with Social Anxiety Disorder.

Background: There are no volumetric magnetic resonance imaging studies on the pituitary gland in individuals with social anxiety disorder. The present study aimed to investigate pituitary volume in individuals with social anxiety disorder compared to healthy controls due to the correlation between pituitary gland volume and stress response and the hypothalamic-pituitary-adrenal axis and hypothesized that pituitary gland volume would be different in these individuals. Methods: In this study, 21 individuals with social anxiety disorder based on fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and 20 healthy controls were included. Both patient and control groups were scanned with a 1.5-Tesla General Electric (GE) Magnetic Resonance Imaging scanner. Pituitary volume was measured with the manual tracing method. Results: The statistical analysis revealed that the mean pituitary gland volume of the individuals with social anxiety disorder was significantly smaller when compared to that of healthy controls, statistically, as presented inTable 1 [594.10±104.56 mm3 for individuals with social anxiety disorder and 818.01±215.25 mm3 for healthy controls] when it was done by using the analysis of covariance controlled for age (F = 12.979, df = 1, P < .001), sex (F = 11.448, df = 1, P < .001), and total brain volume (F = 10.772, df = 1, P < .001), demonstrating that smaller pituitary volume in social anxiety disorder, when compared to healthy subjects, was an important finding independent of age, sex, or total brain volume. Conclusion: We suggest that social anxiety disorder may be associated with smaller pituitary volume, supporting the notion that anxiety itself could reduce the pituitary volume.

Superior Temporal Gyrus Volumes in Patients With Social Anxiety Disorder.

Objective: To determine if superior temporal gyrus volumes are altered in patients with a social anxiety disorder.Methods: Magnetic resonance imaging (MRI) was utilized to determine the superior temporal gyrus volume in 21 patients with a social anxiety disorder and 20 control subjects without a social anxiety disorder. The superior temporal gyrus volumes were measured by manual tracing method. The study was conducted between September 2019 and April 2020.Results: The mean superior temporal gyrus volume for both sides was statistically significantly smaller than that of control subjects (left side: 11.38 ± 0.85 cm3 for patients and 12.73 ± 0.86 cm3 for controls, t=-5.064, P < .001; right side: 11.42 ± 0.84 mm3 for patients and 12.92 ± 0.85 cm3 for controls, t=-5.574, P < .001). Moreover, when comparing volumetric measurements for subregions, we detected that volumes of all subregions were also statistically significantly smaller than those of healthy comparisons (for both sides of the Heschl's gyrus and planum temporale).Conclusions: The study findings suggest that patients with social anxiety disorder seem to have smaller superior temporal gyrus volumes compared to healthy control subjects, although we do not know whether these results were in accordance with functional changes of the same region.

1HMRS in the Hippocampus of the Female Patients with Conversion Disorder.

INTRODUCTION: Previously, we found a lower NAA (N-acetyl aspartate)/CRE (creatine) ratio in conversion disorder patients, when compared to healthy controls. In this context, the present study was designed to determine the changes in hippocampal NAA, CHO (choline), and CRE values in conversion disorder female patients, which has similar symptom basement and hypothesize that the patients with conversion disorder would have also changed neurochemicals in their hippocampal regions. METHOD: Twenty female patients and healthy controls were included in the study. Proton magnetic resonance spectroscopy (1HMRS) method was used to determine the NAA/CHO, NAA/CRE, and CHO/CRE ratios. RESULTS: The data were analyzed via age-controlled General Linear Model and it was found that the ratio of NAA/CHO was significantly lower in conversion disorder female patients when compared to healthy controls. However, NAA/CRE or CHO/CRE ratios were similar for conversion disorder patients and healthy controls. CONCLUSION: It was concluded that conversion disorder female patients might have reduced NAA/CHO ratio which implicates reduced neuronal viability, possibly related to anxiety and indirectly to somatoform symptoms.

Magnetic resonance imaging histogram analysis of corpus callosum in a functional neurological disorder

Background/aim: The aim of the present study was to examine and compare the corpus callosum (CC) via histogram analysis (HA) on T1-weighted MR images of patients diagnosed with Functional Neurological Disorder (FND) and healthy controls. Materials and methods: The study group included 19 female patients diagnosed with FND, and the control group included 20 healthy subjects. All participants were scanned with a 1.5 T MR scanner. A high-resolution structural image of the entire brain was obtained with sagittal 3D spiral fast spin echo T1-weighted images. Gray level intensity, standard deviation of the histogram, entropy, uniformity, skewness, and kurtosis values were determined with texture analysis. A student's t-test was used to compare the group data. P < 0.05 was accepted as statistically significant. Results: It was determined that the mean gray level intensity, standard deviation of the histogram, entropy calculated by the maximum, median and variance and size M percentage values were higher in patients with FND. Kurtosis and size U percentages values were lower in patients with FND. Conclusion: In the present study, analysis of CC with T1-weighted MR image HA demonstrated significant differences between FND patients and healthy controls. The study findings indicated that HA is a beneficial technique for demonstrating textural variations between the CCs of patients with FND and healthy controls using MR images.

Insula volumes are altered in patients with social anxiety disorder.

OBJECTIVE: In the present study, we aimed at examining the volumes of the insula in more pure patients with a social anxiety disorder. METHODS: We examined twenty-one patients with social anxiety disorder according to DSM-IV and twenty healthy controls. All patients and controls were applied to magnetic resonance imaging (MRI). Insula volumes were measured by using the manual tracing method in accordance with the standard anatomical atlases and related previous studies on insula volumes. RESULTS: We found that the mean posterior and anterior insula volumes for both sides of patients were statistically significantly reduced compared to those of healthy control subjects. CONCLUSION: Consequently, in the present study, we found that patients with a social anxiety disorder had reduced insula volumes compared to those of healthy control subjects. However, to get strong this finding, novel studies with a larger sample size are required.

Orbito-frontal cortex and thalamus volumes in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

Background The effect of a variety of treatment modalities including psychopharmacological and cognitive behavioral therapy on the brain volumes and neurochemicals have not been investigated enough in the patients with obsessive-compulsive disorder. Therefore, in the present study, we aimed to investigate the effect of cognitive behavioral therapy on the volumes of the orbito-frontal cortex and thalamus regions which seem to be abnormal in the patients with obsessive-compulsive disorder. We hypothesized that there would be change in the volumes of the orbito-frontal cortex and thalamus. Methods Twelve patients with obsessive-compulsive disorder and same number of healthy controls were included into the study. At the beginning of the study, the volumes of the orbito-frontal cortex and thalamus were compared by using magnetic resonance imaging. In addition, volumes of these regions were measured before and after the cognitive behavioral therapy treatment in the patient group. Results The patients with obsessive-compulsive disorder had greater left and right thalamus volumes and smaller left and right orbito-frontal cortex volumes compared to those of healthy control subjects at the beginning of the study. When we compared baseline volumes of the patients with posttreatment ones, we detected that thalamus volumes significantly decreased throughout the period for both sides and that the orbito-frontal cortex volumes significantly increased throughout the period for only left side. Conclusions In summary, we found that cognitive behavioral therapy might volumetrically affect the key brain regions involved in the neuroanatomy of obsessive-compulsive disorder. However, future studies with larger sample are required.

[Duloxetine-Induced Hypertension: A Case Report]. / Duloksetin Kullanimina Bagli Hipertansiyon: Bir Olgu Sunumu.

Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is used for diabetic neuropathic pain and fibromyalgia as well as major depressive disorder. Serotonin-norepinephrine reuptake inhibitors may lead to increased blood pressure via their noradrenergic effects in addition to their cardiovascular side effects. In this paper, we report a case with increased blood pressure after the initiation of duloxetine that recovered by discontinuation of the medication.

Effects of anti-obsessional treatment on pituitary volumes in obsessive-compulsive disorder.

BACKGROUND: We aimed to examine the effct of anti-obsessional drugs on pituitary gland volumes in the patients with obsessive-compulsive disorder (OCD). SUBJECTS AND METHODS: A group of patients with OCD and of healthy controls were evaluated by using pituitary gland magnetic resonance imaging (MRI) at baseline and after twelve weeks of treatment with selective serotonin re-uptake inhibitors or clomipramine. RESULTS: Pituitary gland volumes were found to be statistically significantly smaller in the patients with OCD compared to healthy control subjects at the beginning of the study. We found that pituitary volumes significantly increased throughout twelve weeks of treatment. CONCLUSIONS: This study provides an evidence of the effect of anti-obsessional treatment on the volumes of pituitary gland in OCD patients.

Orbito-frontal cortex and thalamus volumes in obsessive-compulsive disorder before and after pharmacotherapy.

In the present study, we focused on the key brain regions, OFC and thalamus, to investigate the roles of antiobsessional agents on volume changes of these brain regions after 12 weeks of anti-obsessional treatment in patients with obsessive-compulsive disorder (OCD). Fourteen patients with OCD and the same number of healthy controls were included in the study. At baseline, the volumes of the OFC and thalamus were compared by using magnetic resonance imaging (MRI) between groups. The volumes of OFC and thalamus were evaluated before and after the anti-obsessional drug treatment solely in the patient group. Our study revealed that thalamus volumes were reduced statistically significantly throughout the treatment period. However, we found that OFC volumes did not change statistically significantly throughout the treatment period. In summary, our study found that anti-obsessional drug treatment had an effect on thalamus volumes throughout the treatment period for both sides but not on OFC volumes. However, future studies with larger sample are required.

Pituitary volumes are changed in patients with conversion disorder.

Our study group previously measured pituitary volumes and found a relationship between somatoform disoders and pituitary volumes. Therefore, in conversion disorder, another somatoform disorder, we hypothesized that pituitary gland volumes would be reduced. Twenty female patients and healthy controls were recruited to the present investigation. The volumes of the pituitary gland were determined by using a 1.5 Tesla magnetic resonance scanner. We found that the pituitary gland volumes of the patients with conversion disorder were significantly smaller than those of healthy control subjects. In the patients with conversion disorder but not in the healthy control group, a significant negative correlation between the duration of illness and pituitary gland volume was determined. In summary, in the present study, we suggest that the patients with conversion disorder have smaller pituitary volumes compared to those of healthy control subjects. Further studies should confirm our data and ascertain whether volumetric alterations determined in the patients with conversion disorder can be changed with treatment or if they change over time.

1HMRS results of hippocampus in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

OBJECTIVE: In the present study, we examined the effects of cognitive behavioral therapy (CBT) on the hippocampal neurochemistry in patients with obsessive-compulsive disorder (OCD). METHODS: Twelve patients with OCD and same number of healthy controls were included into the study. Neurochemical variables of the hippocampus were measured before and after the CBT treatment in the patient group. RESULTS: At baseline, the patients with OCD had significantly lower ratio of N-acetyl-l-aspartate/choline (NAA/CHO) compared with that of healthy control subjects. When comparing pre-treatment results of the patient group with those of post-treatment ones using paired t-test, we found that NAA/CHO ratio increased from 2.47 ± 0.64 to 3.66 ± 0.88, with a statisical significance. CONCLUSIONS: The findings may implicate that CBT increases the level of NAA which is a marker of neuronal integrity.

Pituitary volumes of the patients with borderline personality disorder are not changed.

Although it has important relationships with psychiatric symptoms via the hypothalamic-pituitary-adrenal axis, there have been limited investigations of pituitary neuroimaging in psychiatric disorder. Moreover, there have been no studies of borderline personality disorder. In the present investigation, we examined pituitary gland volumes in patients with borderline personality disorder. Seventeen right-handed female patients with borderline personality disorder, selected among the patients who had presented to Firat University School of Medicine Department of Psychiatry outpatient and inpatient clinics, and the same number of healthy control subjects were included in the present investigation. Pituitary gland volumes were manually detected. The results demonstrated that the mean volumes of the gland of the patients with borderline personality disorder were not significantly different than those of healthy control subjects (mean volume of 0.79 cm3 in the patient group, with a value of SD±0.11 and 0.81 cm3 in the healthy control group, with a value of SD±0.23; t=-0.21; p>0.05).

Neurochemical alterations associated with borderline personality disorder.

In neuroimaging on borderline personality disorder, prior studies focused on the hippocampus and amygdala, as mentioned above. However, no study investigated whether there were neurochemical changes in the patients with borderline personality disorder. Therefore, in the present study, we aimed to investigate neurochemical change of patients diagnosed with borderline disorder and hypothesized that neurochemicals would change in the hippocampus region of these patients. Seventeen patients and the same number of healthy control subjects were analyzed by using a 1.5 Tesla GE Signa Imaging System. N-acetylaspartate (NAA), choline compounds (CHO), and creatine (CRE) values of hippocampal region were measured. The mean NAA/CRE ratio in the hippocampus region was significantly reduced in the patients with borderline personality disorder compared to that of healthy control subjects, In addition, NAA/CHO ratio of the patients with borderline personality disorder was also significantly reduced when compared to that of healthy subjects. There was no difference in the ratio of CHO/CRE. In summary, we present evidence for reduced NAA in the patients with borderline personality disorder.

A case of Ventricular Tachycardia and Cardiac Arrest Associated with Sertraline and Mirtazapine Combination.

A 67-year-old male suffering from depressive symptomatology was admitted to the inpatient clinic at Firat University School of Medicine; and his psychiatric evaluation revealed major depressive episode according to DSM-IV. He developed chest discomfort, chest pain and shortness of breath of acute onset accompanying pulseless ventricular tachycardia (VT) leading to cardiac arrest following sertraline and mirtazapine combination treatment. He died after two days in the Intensive Care Unit. The present case suggests that psychiatrists should be aware of unexpected cardiac events, especially when they use combination treatments.

Mirtazapine augmentation for selective serotonin reuptake inhibitor-induced sexual dysfunction: a retropective investigation.

The aim of the present study was to retrospectively identify sexual dysfunction changes in the patients under mirtazapine-augmented serotonin reuptake inhibito (SSRI) treatment. The study comprised medical records of 20 outpatients, under mirtazapine-augmented SSRI treatment for their major depressive disorder, who had been selected among the patients that had developed sexual dysfunction to previous treatment as monotherapy, with SSRI for at least six weeks. These drugs were maintained and mirtazapine were added (15-45 mg/day). There was a significant difference in scores between baseline and week 4 or week 8 on the both Hamilton Depression Rating and Arizona Sexual Experience Scale. According to Clinical Global Impression-Improvement, 68.4% of the patients were responders. The use of low-dose mirtazapine as an add-on treatment to SSRIs appears to be an effective and well-tolerated augmenttaion for sexual dysfunction caused by SSRIs.

Serotonin transporter gene polymorphism implicates reduced orbito-frontal cortex in obsessive-compulsive disorder.

Although a number of magnetic resonance imaging (MRI) and genetic studies have been performed on obsessive-compulsive disorder (OCD), only limited studies in which genetic and neuroanatomical variables are evaluated concurrently have been performed. Therefore, the aim of our present study is (to understand) better understanding how genetic variation in the promoter region of the 5-HTT gene (5-HTTLPR) is associated with key brain structures in OCD, orbito-frontal cortex (OFC), thalamus and anterior cingulate. 5-HTT genotypes (SS, SL, LL) were determined for 40 patients with OCD and the same number of healthy controls. MRI-derived volumes of the OFC, thalamus, and anterior cingulate were determined by reliable tracing techniques. Volumetric measurements were made with T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5T, and were done blindly. In comparison with controls, OCD patients demonstrated volumes reduction in OFC, increased volumes of thalamus and total white matter volumes, but no difference in total brain volume, total gray matter volumes and anterior cingulate volumes. No significant difference was observed in allelic frequencies between the patients and controls. The stronger effects of 5-HTT polymorphism on brain morphology in OCD than those in controls were determined in the both OFC and thalamus. On the other hand, for the OCD patients, ANCOVA revealed a significant main effect of genotype for both the OFC and thalamus and a significant genotype-by-side interaction for the OFC, demonstrating that the short variants had a smaller right OFC than the long variants. In conclusion, we found a significant genotype-diagnosis interaction effects on key brain structures, with a stronger effects of 5-HTT polymorphism in OFC and thalamus of OCD patients, whereas no morphological changes related to the polymorphism were found in normal individuals.