Death Anxiety and Related Factors in Schizophrenia Patients: Controlled Study.

The aim of the study was to investigate the level of death anxiety and related sociodemographic and clinical variables in schizophrenia patients. One hundred and ninety schizophrenia patients and 110 healthy controls were included the study. Death anxiety measured with Templer Death Anxiety Scale (TDAS). The patients were also evaluated with scales in terms of depression, anxiety, obsessive-compulsive symptoms, and suicide. The death anxiety level in patients with schizophrenia was significantly higher than the healthy controls. The severity of depressive and psychotic symptoms were related to the level of death anxiety. Patients with schizophrenia may need more protection and psychosocial interventions about death related themes.

White matter characteristics in the early and late stages of bipolar disorder: A diffusion tensor imaging study.

BACKGROUND: Bipolar disorder (BD) is characterized by recurrent mood episodes that may progress over time. Staging models may be used to follow the long-term course of BD. BD is associated with microstructural changes in white matter (WM). This study aims to compare the WM integrity within patients groups who are in different stages of BD and healthy controls and investigate whether WM integrity changes may be a biomarker that can be used in the clinical staging of BD. METHODS: The study sample included euthymic 54 patients diagnosed with BD according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and 27 healthy volunteers. Early-stage patients (n = 26) were determined as patients who have not had any mood episodes after the first manic episode, and late-stage patients (n = 28) determined as patients with recurrent mood episodes. MRI was performed using a 1.5 Tesla MR system and DTI sequences were acquired. RESULTS: Region of interest (ROI) analyses showed that late-stage patients had significantly reduced fractional anisotropy (FA) in the right sagittal stratum and genu of the corpus callosum compared with healthy controls and early-stage patients. Regression models show that corpus callosum genu and right sagittal stratum FA values are predictive for the late-stage patient group. LIMITATIONS: There are some limitations of the ROI method. The cross-sectional design is another limitation of this study. CONCLUSIONS: WM integrity of corpus callosum genu and right sagittal stratum may be a biomarker for clinical staging of BD. Identifying stage-specific biomarkers may help us predict the neuroprogressive course of BD. Longitudinal studies would be required to detect stage-specific biomarkers.

Neurotrophic Factor Levels and Cognitive Functions before and after the Repetitive Transcranial Magnetic Stimulation in Treatment Resistant Depression.

OBJECTIVE: To determine relationship between the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive impairment and brain derived neurotrophic factor (BDNF), glial cell derived neurotrophic factor (GDNF) levels in treatment resistant depression (TRD). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Psychiatry Clinic of Konya Beyhekim Training and Research Hospital in Turkey, between June and November 2019. METHODOLOGY: The study included 33 TRD patients and 33 healthy subjects. Patients received a total of 20 sessions of rTMS treatment. Serum BDNF and GDNF levels were measured before and after rTMS treatment. Additionally, the severity of depression as well as cognitive functions were assessed at the baseline and after the treatment. RESULTS: The rTMS treatment significantly improved depressive and cognitive symptoms in patients with TRD. Although the level of serum BDNF and GDNF increased after rTMS treatment, it was associated with the improvement in symptoms, but not significantly. CONCLUSIONS: rTMS treatment contributes to the antidepressant effect by normalising serum BDNF and GDNF levels in patients with TRD. Adding rTMS to antidepressants is, therefore, an appropriate treatment option for depressive patients with cognitive impairment. Key Words: rTMS, BDNF, GDNF, Cognitive function.

Ganglion cell complex thickness changes in patients with different states of bipolar disorder.

OBJECTIVES: Neuroimaging studies in patients with bipolar disorder have suggested that a neuropathological process may be effective in this disease. Neurodegenerative changes in the retina can be followed by optical coherence tomography, a non-invasive imaging method that allows in vivo visualization of the retinal layers. The aim of this study was to investigate the possible differences in optical coherence tomography parameters during euthymic, manic, and depressive episodes in patients diagnosed with bipolar disorder. METHODS: A total of 150 patients with bipolar disorder were included in the study, divided into three groups (50 patients in a euthymic state, 50 patients in a manic state, and 50 patients in a depressive state) and compared with 50 healthy controls. Ganglion cell complex thickness was measured with automated macular segmentation software of spectral-domain optical coherence tomography. RESULTS: Ganglion cell complex thicknesses were thicker in all quadrants in patient groups than the control group but the differences were significant in perifoveal superior and perifoveal inferior quadrants (p < 0.001, p < 0.001). There were no differences in ganglion cell complex thickness among the patient groups (p > 0.05). CONCLUSION: The evaluation of ganglion cell complex thickness by spectral-domain optical coherence tomography may give a clue for monitoring neurodegenerative changes in patients with bipolar disorder.

Predictors of Caregiver Burden in Family Caregivers of Male Patients with Opioid Use Disorders.

Background: We aimed to determine the factors that correlate and best predict caregiver burden in family caregivers of male patients with opioid use disorders, specifically with heroin use. Methods: A total of 100 patients with opioid use disorders and their primary caregivers (n = 100) were included in the study. Both patients and caregivers completed sociodemographic data collection forms. The Addiction Severity Index was applied to the patients, and the Burden Assessment Scale, COPE Inventory, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale were applied to the caregivers. Patients and their caregivers were divided into groups according to sociodemographic and clinical characteristics and then the caregiver burden scores were compared. In addition, factors correlating with caregiver burden were determined. Finally, in considering all these data, the factors that best predict caregiver burden were identified using regression analysis. Results: Factors that increased the burden of caregivers were duration of care, at least 1 instance of inpatient treatment, the presence of verbal and physical violence between patients and other family members, intravenous drug use, and moderate or severe dependence, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Caregivers' active coping scores, based on the COPE Inventory, were found to negatively predict caregiver burden, while the patients' family-social relationship scores, based on the Addiction Severity Index, were found to positively predict caregiver burden. Conclusions: Developing caregivers' coping skills and patients' family-social relationships may thus contribute to reducing the burden of disease related to heroin-addicted patients.

Delirium After Pregabalin Withdrawal.

Pregabalin is a γ-amino butyric acid analogue drug that is used in fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, spinal cord injury, and postherpetic neuralgia. Symptoms reported in association with pregabalin withdrawal include insomnia, gastrointestinal distress, tachycardia, and headache. This case report describes a 68-year-old patient who developed delirium after experiencing pregabalin withdrawal. Clinicians should be aware of the possibility of pregabalin withdrawal delirium.

The effects of adding long-acting injectable antipsychotic drugs to clozapine on relapse and hospitalization in patients with treatment-resistant schizophrenia: a mirror-image retrospective study.

The literature assessing the addition of long-acting injectable antipsychotics (LAIs) to clozapine is limited. The aim of this retrospective study was to determine the safety and effectiveness of adding LAIs to clozapine in patients with treatment-resistant schizophrenia (TRS). Patients aged 18-65 years with TRS, who were treated with first-generation (FGA-LAIs) and second-generation (SGA-LAIs) for at least 1 year after clozapine use, were included retrospectively by registration system scanning. Effectiveness measures included relapses and hospitalizations and days of hospitalization. Safety outcomes included levels of neutrophils, fasting blood sugar, total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and prolactin. The data of 29 patients who met the study criteria were evaluated. The numbers and days of hospitalizations and the numbers of relapses significantly decreased after LAI addition. Comparisons of the neutrophil counts and the total cholesterol, triglyceride, HDL, LDL, prolactin, and fasting blood glucose levels as safety indicators of the clozapine and LAI combination revealed no statistically significant change in these values before and after LAI addition. Adding LAIs to clozapine is apparently well tolerated in patients with TRS and may have a positive effect on the course of the disease.

Impact of initiating long-acting injectable paliperidone palmitate on relapse and hospitalization in patients with bipolar I disorder: A mirror image retrospective study.

Literature assessing the use of long-acting injectable paliperidone palmitate in patients with bipolar I disorder is limited. The aim of this retrospective study was to determine the effectiveness of long-acting injectable paliperidone palmitate treatment on relapse and hospitalization in a real-world setting. Patients with bipolar I disorder aged 18-65 years, who were treated with paliperidone palmitate once-monthly (PP1M) for at least one year, were included. The rate of relapse, hospitalization, and length of hospital stay were collected. Safety outcomes included levels of prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein. The data of 36 patients who met the study criteria were evaluated. Number and length of hospitalizations, number of manic and mixed episodes significantly decreased after PP1M addition. When we compared the prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein levels as an indicator of the safety of treatment, there was no statistically significant change in these values before and after PP1M addition. Our findings suggested PP1M may be effective in reducing manic and mixed episodes. Limitations include a mirror image retrospective design and small sample size.

Autistic Traits in Men With Substance Use Disorder.

There has been no study in the literature evaluating autistic traits (ATs) in men with substance use disorders (SUDs). Therefore, we performed the current study to evaluate whether there is a relation between the ATs among men with SUDs and normal controls. A total of 142 men with SUDs and 109 age and sex-matched healthy controls were included in the current study. Present attention deficit hyperactivity disorder (ADHD) symptoms of the participants were evaluated using the Adult ADHD Self-Report Scale. The autism spectrum quotient (AQ) was used to evaluate ATs. The current study found that higher AQ imagination and lower AQ attention to detail scores predicted SUDs after controlling for AQ subscales and present ADHD symptoms. This study shows that ATs may be engaged in the development of SUDs. To explore the connection between ATs and SUDs, more research is needed.

Assessment of depressive symptoms, self-esteem, and eating psychopathology after laparoscopic sleeve gastrectomy: 1-year follow-up and comparison with healthy controls.

PURPOSE: The aim of this study was to assess depressive symptoms, self-esteem, and eating psychopathology in bariatric surgery patients at the preoperative period (t0) and at the 6-month (t1) and 12-month (t2) follow-ups after laparoscopic sleeve gastrectomy (LSG). A second aim was to investigate associations between these variables and weight loss. METHOD: The study participants were 48 bariatric surgery candidates and 50 non-obese controls. Both groups underwent assessment with the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Eating Disorder Examination Questionnaire (EDE-Q), and Rosenberg Self-esteem Scale (RSES). These assessments were repeated for the patient group at t1 and t2. RESULTS: The HDRS, RSES, and EDE-Q scores were higher in the patients before LSG (t0) than in the control group. A significant progressive improvement was identified in the patient HDRS and RSES scores as well as EDE-Q weight and shape subscale scores at t1 and t2. However, the patient EDE-Q total and dietary restraint scores improved at t1 then stabilized. The patient EDE-Q eating concern subscale improved at t1, but then worsened. The patient HDRS scores at t2 were similar to the control group, but the EDE-Q and RSES scores were still higher than the control scores at t2. Regression analyses revealed no association between the preoperative scores and percent changes in postoperative scores for any scale and patient weight loss at t2. CONCLUSION: Depressive symptoms, self-esteem, and eating psychopathology showed an improving trend in patients after LSG. However, some aspects of eating psychopathology worsened despite an initial improvement. LEVEL OF EVIDENCE: III, prospective cohort and case-control study.

Affective temperaments in caregiver of patients with bipolar disorder and their relation to caregiver burden.

BACKGROUND: Bipolar disorder (BD) is impose a severe burden on caregivers. The aspects of the burden should be evaluated from broad perspective, because caregivers contribute greatly to the treatment process. Affective temperaments are widely distributed in the population, in their mild forms can provide adaptive properties. The aim of this study was to assess the affective temperaments among caregiver of patients with BD and to evaluate the impact of affective temperaments on the burden. METHODS: The study sample included 101 caregivers of patients diagnosed with BD type I according to DSM-5 and 107 healthy volunteers. The Temperament Evaluation of the Memphis, Pisa, Paris and San Diego self-report questionnaire (TEMPS-A), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS) were administered to both groups, and the Burden Assessment Scale (BAS) was administered to caregivers. RESULTS: The hyperthymic and depressive temperament scores were higher in the caregivers than in the controls, and hyperthymic and depressive temperaments were predictor factors for caregiver. Irritable temperament also adversely affected the caregiver burden, but hyperthymic temperament was not related to development of burden. The mean BAS score was 43.2 ±â€¯11 for the caregivers. The caregiver HDRS and HARS scores and the number of manic episodes were related to the level of burden. LIMITATION: Cross-sectional study CONCLUSION: Affective temperaments may be related to being a caregiver and to the caregiver burden. Hyperthymic and depressive temperaments may indicate predisposition for being a caregiver. Irritable temperament adversely affects burden, whereas hyperthymic temperament could protect the caregiver from burden.

Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder.

Background: Currently, increasing evidence supports the hypothesis that alterations in the immune-inflammatory system are critical for the pathophysiology of bipolar disorder (BD). Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and mean platelet volume (MPV) have recently been investigated as inexpensive and simple inflammatory markers. Aims: The aim of this study is to compare NLR, PLR, MLR, and MPV in depressive, manic, and euthymic patients with BD and healthy controls, and to evaluate whether values of NLR, PLR, MLR, and MPV are possible state or trait biomarkers in BD. Methods: This retrospective study was conducted with 341 patients with BD (100 patients in a depressive state, 141 patients in a manic state, and 100 patients in a euthymic state) and 114 healthy controls. Results: We found that patients with BD in manic states had higher levels of MPV, NLR, and MLR, and patients with BD in depressive states had higher levels of MPV than the controls. Moreover, MPV predicted all states of BD, while NLR and MLR predicted the manic state of BD. Conclusions: NLR, MLR, and MPV obtained from simple and inexpensive blood tests were significantly higher in patients with BD than in healthy controls, which each imply low-grade inflammation. MPV may serve as a possible trait biomarker of BD, while NLR and MLR may both serve as possible state biomarkers of the manic state.

Increased Neutrophil-lymphocyte and Platelet-lymphocyte Ratios in Male Heroin Addicts: A Prospective Controlled Study.

OBJECTIVE: The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are markers that can determine the presence of systemic inflammatory response. In this study, we examined the NLR and PLR levels in patients with heroin dependence compared to healthy controls. METHODS: The study sample included 90 male patients with heroin dependence aged 18 to 45 years and 60 healthy subjects who had similar socio-demographic characteristics as the patient group. The diagnoses of heroin dependence and other Axis I psychiatric disorders in the patient and control groups were screened with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). The extent of heroin addiction was assessed with the Addiction Severity Index (ASI). RESULTS: The mean NLR and PLR levels of patients with heroin dependence were significantly higher than the control subjects (p=0.031 and p<0.001, respectively). Positive correlations were found between NLR, PLR and duration of the disorder. CONCLUSION: Our results indicate that inflammatory processes may play a role in the pathophysiology of heroin dependence.

Dynamic thiol disulphide homeostasis in operating theater personnel exposed to anesthetic gases.

BACKGROUND: The purpose of this study was to investigate the association between dynamic thiol/disulphide homeostasis and occupational exposure to volatile anesthetic gases in operating theater personnel. Decreased blood thiol levels and raised blood disulphide levels serve as biomarkers of oxidative stress. METHODS: We included 65 subjects occupationally exposed and 55 unexposed healthy medical professionals into the study. A novel method enabled separate measurements of components involved in dynamic thiol/disulphide homeostasis (native thiol, disulphide, and total thiol). To control for the potential confounding effect on oxidative stress of psychological symptoms potentially caused by occupational stress, we used scores obtained from four different anxiety and depression inventories. RESULTS: Mean ± standard deviation native thiol was found to be 433.35 ± 30.68 in the exposed group, lower than among controls, 446.61 ± 27.8 (P = 0.02). Disulphide in the exposed group was 15.78 ± 5.12, higher than among controls, 12.14 ± 5.33 (P < 0.001). After adjusting for anxiety and depression scores, age and gender, native thiol remained lower and disulphide higher in the exposed group (P = 0.008 and P < 0.001). CONCLUSION: Dynamic thiol/disulphide homeostasis in workers exposed to anesthetic gases was found to be disturbed after adjusting for the possible contribution of anxiety. We infer that this is due to the oxidative effect of exposure to anesthetic gases.

Aripiprazole-induced Asymptomatic Hypertension: A Case Report.

Aripiprazole is a second generation antipsychotic widely prescribed for the treatment of psychiatric diseases. It is generally known that antipsychotics have hypotensive effects. In this case report, however, we present the case of a medically healthy patient with schizophrenia who developed hypertension (HT) after the initiation of aripiprazole. The patient's blood pressure returned to normal after discontinuation of aripiprazole, suggesting that aripiprazole may have led to asymptomatic acute HT.

The Red Blood Cell Acetylcholinesterase Levels of Depressive Patients with Suicidal Behavior in an Agricultural Area.

Long-term exposure to organophosphate pesticides (OPs) without acute poisoning can lead to various OPs. Environmental exposure to organophosphate pesticides may be associated with depression and suicide attempts in a population living in a rural agricultural area. Patients (n = 149) suffering from major depressive disorder (with and without attempted suicide) and a control group of healthy individuals (n = 64) who had been living in the same rural district for at least 1 year were selected. Red blood cell acetylcholine esterase (RBC-AChE) activity was examined as the basis of evaluating the degree of chronic environmental exposure to OPs residues. There were negative association between RBC-AChE activity levels and suicide attempts, the number of past suicide attempts and hopelessness levels in the depressive patients. The results of the study may support the idea that environmental exposure to OPs may be associated with mental health in individuals living in agricultural districts who are not farmers or working in occupations with access to OPs.

Continuing clozapine treatment with lithium in schizophrenic patients with neutropenia or leukopenia: brief review of literature with case reports.

OBJECTIVE: Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia. Despite its effectiveness, clozapine is largely underused due to serious side effects such as leukopenia or neutropenia. We aimed to review whether to continue, discontinue or rechallenge clozapine treatment after such haematological side effects. METHODS: We reviewed and summarized the literature on the use of clozapine, how to deal with its side effects, and suitable options in case of any haematological problems. Then, we described several cases successfully treated with clozapine and lithium after development of neutropenia or leukopenia. RESULTS: We present three patients with treatment-resistant schizophrenia. While they had demonstrated poor response to multiple antipsychotic trials, clozapine was started. Clozapine induced neutropenia; or leukopenia developed in some cases that was successfully reversed after lithium onset. Increased serious side effects related with coprescription of lithium and clozapine were not observed. CONCLUSION: Lithium increases neutrophil and total white blood cell count as a side effect that may be useful in patients who develop neutropenia or leukopenia while being treated with clozapine.

Burden of care and quality of life in relatives of opioid dependent male subjects.

BACKGROUND: The aim of this study was to compare the quality of life (QoL) and family burden in relatives of patients with heroin dependence with that of healthy controls. SUBJECTS AND METHODS: A total of 50 heroin dependent patients and 50 of their relatives and 50 healthy subjects and 50 of their relatives were included in the study. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I) was used to determine the heroin dependence and other Axis I psychiatric disorders. Family burden and QoL levels in the relatives were assessed with the Zarit Burden Interview (ZBI) protocol and the World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF), respectively. RESULTS: There were no significant differences in demographic characteristics between the groups. When compared with healthy controls, family members of heroin dependence patients had significantly higher ZBI scores and significantly lower all subscale scores of the WHOQOL-BREF. ZBI score was positively correlated with duration of the illness. All WHOQOL-BREF subscale scores were negatively correlated with duration of the illness. CONCLUSIONS: The study suggests that heroin dependence not only affects the lives of patients but also the lives of their family members. Heroin dependence leads to high burden on the family and also impairs the QoL of relatives.

Plasma 8-isoPGF2α and serum melatonin levels in patients with minimal cognitive impairment and Alzheimer disease.

BACKGROUND/AIM: F2α-isoprostane is accepted as an oxidative stress indicator and melatonin shows neuroprotective effects by antioxidative and antiamyloidogenic influences. By measuring these in patients diagnosed with minimal cognitive impairment (MCI) and Alzheimer-type dementia, we intended to demonstrate whether the measurement of these markers contributes to early diagnosis of Alzheimer disease (AD) in the MCI stage or not. MATERIALS AND METHODS: Three groups (n = 63) were created: the AD group, MCI group, and control group. Serum melatonin levels were measured by radioimmunoassay method, and plasma total 8-isoPGF2α levels were measured by enzyme immunoassay method. RESULTS: Significant differences were observed in the melatonin levels between the MCI group and AD group (P = 0.009), and in 8-isoPGF2α levels between the AD group and control group (P = 0.022). A negative correlation between mini-mental state examination (MMSE) scores and 8-isoPGF2a levels (r = -0.459, P < 0.001) and positive correlation between MMSE scores and melatonin levels (r = 0.317, P = 0.011) were found. CONCLUSION: Although the plasma 8-isoPGF2α and serum melatonin levels in MCI were not found to be good early diagnostic markers to indicate risk of AD, results were found to support the role of oxidative stress in AD.

Relationship of asymmetrical dimethylarginine, nitric oxide, and sustained attention during attack in patients with major depressive disorder.

We investigated the relationship of serum nitric oxide (NO) and asymmetrical dimethylarginine (ADMA) levels with cognitive functioning in patients with major depressive disorder (MDD). 41 MDD patients (Beck depression scale scores>16) and 44 controls were included in the study. Rey verbal learning and memory test, auditory consonant trigram test, digit span test, Wisconsin card sorting test, continuous performance task (TOVA), and Stroop test scores were found to be impaired in patients with major depressive disorder when compared to healthy controls. There was no significant difference between patient and control groups in terms of serum NO and ADMA. Serum NO levels were correlated with TOVA test error scores and Stroop test time scores, whereas serum ADMA levels were negatively correlated with TOVA test error scores. Metabolic detriments especially in relation to NO metabolism in frontal cortex and hypothalamus, psychomotor retardation, or loss of motivation may explain these deficits.