Insight in schizophrenia is associated with psychoeducation and social support: Testing a new more comprehensive insight tool in Turkish schizophrenia patients.

Insight is a continuous and multidimensional phenomenon, including awareness of having an illness, the presence of symptoms and accurate symptom attribution, the need for treatment, and the consequences of treatment. Good insight into illness is associated with better adherence to treatment, better cognitive, psychosocial, and vocational functioning along with less symptom severity, decreased relapses, and hospitalizations. Several tools are used for insight evaluation. We recruited 90 patients diagnosed with schizophrenia and analyzed the forms of 58 patients. The patients completed the VAGUS-SR (self-rated), Beck Cognitive Insight Scale, Knowledge About Schizophrenia Questionnaire, and Multidimensional Scale of Perceived Social Support (MSPSS). Clinicians performed a mental status examination and completed the Positive and Negative Syndrome Scale, Schedule for the Assessment of Insight, VAGUS-CR (clinician-rated), Calgary Depression Scale for Schizophrenia, and Clinical Global Impressions. We found that the level of insight evaluated using the VAGUS forms increased with knowledge regarding schizophrenia. Upon investigating the relationship between perceived social support and insight, we identified a relationship between VAGUS-CR and only significant other subscales of MSPSS, and between one of the VAGUS-SR scale sub-dimensions and significant other and total scores of MSPSS. Our findings also suggest that the VAGUS-SR and VAGUS-CR scales can be used to evaluate insight in Turkish populations. The positive relationship between perceived social support and insight emphasizes the importance of increasing social support through interventions aimed at improving insight. Our data also highlighted the value of psychoeducational studies in this patient group. Considering the multidimensional effects of insight on patients with schizophrenia, it would be beneficial to use scales such as VAGUS, which allow the insights of individuals to be evaluated in detail by both the clinician and the patient.

Evaluation of Effects of Titanium Dioxide and Zinc Oxide Nanoparticles on Baker's Yeast (Saccharomyces cerevisiae) Glutathione Reductase Activities.

The glutathione reductase (GR) of baker's yeast (Saccharomyces cerevisiae) was exposed to titanium dioxide nanoparticles (TiO2 NPs) and zinc oxide nanoparticles (ZnO NPs) at concentrations of 0, 25, 50, 100, 250, and 500 mg/L (ppm) in vitro. According to the calculations, the effect of 25, 50, 100, 250, and 500 mg/L TiO2 NPs on GR enzyme activities resulted in percentage changes of - 3.12; - 0.87; - 2.12; - 2.12, and - 1.50, respectively. Percentage changes in GR enzyme activities with the effect of 25, 50, 100, 250, and 500 mg/L ZnO NPs were calculated as - 2.01; + 1.88; + 0.38; - 2.51, and + 0.75, respectively. It can be deduced from this research that the change in concentrations of TiO2 NPs and ZnO NPs has no statistically significant effect on GR enzyme activities in comparison with the control groups (p > 0.05, N = 3).

The relationship between self-esteem, body dissatisfaction, and eating attitudes in bariatric surgery candidates.

Objectives: Considering the effects of self-esteem, eating attitudes and body satisfaction on obesity and bariatric surgery outcomes, psychiatric evaluation is important for the identification and treatment of psychopathology, improvement of self-esteem, eating attitudes and body satisfaction. In this study, it was aimed to determine the relation between eating behaviors, body dissatisfaction, self-esteem and psychological symptoms in patients seeking bariatric surgery. Our second aim was to determine whether depressive symptoms and anxiety had a mediating role in the relationship between body satisfaction and self-esteem and eating attitudes. Material and Methods: The study included 200 patients. Patients' data were retrospectively evaluated. Psychometric evaluation performed during the preoperative period included psychiatric examination and administration of the Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg SelfEsteem Scale, Body-Cathexis Scale, and Dutch Eating Behaviors Questionnaire. Results: There was a positive correlation between self-esteem and body satisfaction and a negative correlation between self-esteem and emotional eating (r= 0.160, p= 0.024; r= -0.261, p <0.001 respectively). Body satisfaction had an effect on emotional eating mediated by depression and an effect on external and restrictive eating mediated by anxiety. Furthermore, anxiety mediated the relations between self-esteem and external and restrictive eating behaviors. Conclusion: Our finding indicating that depression and anxiety have mediator effects on the relation between self-esteem, body dissatisfaction, and eating attitudes is significant since screening for these entities and their treatment is relatively more practical in clinical settings.

Serum TNF- Related Weak Inducer of Apoptosis (TWEAK), TNF- Related Apoptosis-Inducing Ligand (TRAIL) Levels in Patients with Bipolar Depression, Major Depression and a Healthy Control Group.

BACKGROUND: A low-grade inflammation is presumed to be related to the etiopathogenesis of major depressive disorder (MDD) and bipolar disorder. Tumor necrosis factor (TNF) superfamily members have roles in the pathogenesis of neuropsychiatric disorders because of the relationship with inflammation and neurogenesis. The aim of this study was to investigate the serum TNF-related weak inducer of apoptosis (TWEAK) and TNF-related apoptosis-inducing ligand (TRAIL) levels in patients with bipolar depression (BD), MDD and a healthy control (HC) group to determine any differences between MDD and BD in terms of inflammation biomarkers. SUBJECTS AND METHODS: After a 12-hour overnight fast, 5 milliliter (mL) samples of fasting blood were obtained from the participants. The TWEAK and TRAIL plasma levels were calculated using ELISA kits. RESULTS: The TWEAK levels were found to be higher in the BD group than in the HC group (p=0.03). No statistically significant differences were determined between the BD vs MDD and MDD vs HC groups (p=0.17, p=0.37, respectively). There were no statistically significant differences between the three groups (BD vs HC; BD vs MDD; MDD vs HC) in terms of TRAIL levels (p=0.21). CONCLUSION: To the best of our knowledge, this study is the first to have explored TWEAK levels in patients with BD. The higher TWEAK levels in BD than in the control group is compatible with the inflammation hypothesis of BD. Limitations of the study were the differences in medications of the patient groups and that it was a cross-sectional study. There is a need for further longitudinal studies with larger sample size and medication-free patients.

Treatment strategies in management of schizophrenia patients with persistent symptoms in daily practice: a retrospective study.

OBJECTIVES: One-third of the patients with schizophrenia show treatment resistance and literature on the effectiveness of interventions in patients with persistent symptoms is conflicting. This study aimed to assess clinical preferences of clinicians in those showing treatment resistance to antipsychotics and to determine correlates of interventions. METHODS: Treatment strategies applied in the patients with schizophrenia in daily practice were inquired retrospectively. Those showing poor response to at least two antipsychotics and were administered a clinical intervention in a University Hospital between January and September 2018 were included. Clinical correlates of distinct interventions were evaluated. RESULTS: The most common intervention (47%) was transition to a long-acting injectable antipsychotic (LAIA) and the second most common (22%) was addition of a second/third oral drug to on-going oral therapy. Switching to clozapine was more effective on positive symptoms comparing with the other interventions (p < 0.01). LAIA therapy showed a superiority over oral antipsychotic interventions at improving positive symptoms, except clozapine (p < 0.01). CONCLUSIONS: LAIA administration and oral antipsychotic augmentation were the most common interventions in the patients with persistent symptoms. Clozapine was related to better clinical improvement in the present study and it might be administered as a second-line treatment in schizophrenia.Key pointsEffectiveness of the treatment strategies in schizophrenia patients with persistent symptoms is not satisfactory to meet expectations of the clinicians yet. Clozapine still seems to be the best option to provide a favourable improvement in TRS.LAIA and oral AP combination are used frequently in schizophrenia for persistent psychotic symptoms and targets of the combination therapies in daily practice needs to be clarified.The most common intervention was transition to a LAIA (47%) in the study and none of the patients administered LAIA had used a long-acting AP before the intervention. High rate of treatment nonadherence in schizophrenia is an important reason for common LAIA preference in the patients with persistent symptoms.Growing evidence indicates that clozapine can be used as a second-line treatment in schizophrenia, and thus, there is an urgent need to increase clozapine use in the patients with persistent symptoms in clinical practice.

Inhibition of Glutathione Reductase Activity from Baker's Yeast (Saccharomyces cerevisiae) By Copper(II) Oxide Nanoparticles and Copper(II) Chloride.

In this study, glutathione reductase (GR) from baker's yeast (Saccharomyces cerevisiae) was exposed to 0, 25, 50, 100, 250 and 500 mg/L copper(II) oxide nanoparticles (CuO NPs) and copper(II) chloride (CuCl2). Changes in GR% activity upon exposure to 25, 50, 100, 250 and 500 mg/L CuO NPs and CuCl2 were found to be + 0.3, - 3.4, - 8.1, - 25.7 and - 37.4 and - 60.7, - 72.7, - 77.8, - 85.3 and - 90.6, respectively. The 50% inhibition concentration (IC50) was 625 ppm (78.6 × 10-4 M) for CuO NPs and 21 ppm (1.56 × 10-4 M) for CuCl2. Moreover, CuO NPs and CuCl2 inhibited GR competitively and noncompetitively, respectively.

Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

ADHD Medication Trends in Turkey: 2009-2013.

OBJECTIVE: To investigate the change of ADHD medication prescriptions in Turkey between 2009 and 2013. METHOD: Consumption data of ADHD medications, immediate release (IR) methylphenidate (MPH; Ritalin), OROS MPH (Concerta), and atomoxetine (Strattera) were obtained from IMS Health database for the November 2008 to October 2013 period. Defined daily dose (DDD) of each drug was calculated according to WHO definitions and time-series analysis was conducted. RESULTS: There was a significant seasonal effect for prescription of all drugs. Annual use of ADHD medications increased 2.18 times for all ADHD medications combined. DDDs per 1,000 population per day for all ADHD medications were 0.28 in 2009, 0.41 in 2010, 0.52 in 2011, and 0.59 in 2012. OROS MPH represented almost 75% of all ADHD medication utilization. CONCLUSION: As reported from several other countries, ADHD medication use increased in Turkey. Results suggested that over- and underdiagnosis might be seen at the same time.

Aripiprazole Induced Acute Transient Bilateral Myopia: A Case Report.

BACKGROUND: Aripiprazole is an atypical antipsychotic drug. Acute transient myopia is a rare response to systemic medication. Unspecified ocular side effects of aripiprazole have rarely been reported. To the best of our knowledge, only 3 cases of aripiprazole induced myopia and diplopia have been reported in the literature. The aim of this article is to present a case of aripiprazole-induced acute transient myopia. CASE REPORT: A 30 year-old woman underwent treatment for 5 days with aripiprazole and presented with bilateral painless blurred vision. The patient's uncorrected visual acuity was 2/10 in both eyes and her best corrected visual acuity was 10/10 in both eyes with a refractive error of -3.00 diopters using a standard Snellen chart. Adding 2 mgs of biperiden a day to her treatment regimen decreased her blurred vision symptoms. After discontinuation of aripiprazole treatment and cross-switching to Paliperidon palmitate (75 mg/month) her blurred vision completely resolved. The same side effect did not re-occur when checked on her 6-month follow up. CONCLUSION: Ophthalmologists as well as psychiatrists must be aware of this myopic shift and should also ask these patients about medicine usage, especially aripiprazole. Ophthalmologists should consult the prescribing psychiatrist and stop the drug immediately to reverse this temporary condition.

Serum S100B Protein Levels in Patients with Panic Disorder: Effect of Treatment with Selective Serotonine Reuptake Inhibitors.

OBJECTIVE: Altered serum S100B protein levels have been shown in several psychiatric disorders. Our aim was to investigate whether plasma S100B is different in patients with panic disorder (PD) when compared with controls. Our second aim was to investigate whether treatment with SSRIs have an effect on S100B levels in patients with PD. METHODS: The sample included 32 patients diagnosed with PD (21 women, 11 men) per DSM-IV criteria and 21 healthy controls (11 women, 10 men). S100B levels were measured with BioVendor Human S100B ELISA (Enzyme Linked Immunosorbent Assay) kit. RESULTS: 14 patients were not on drug treatment (43.8%) while 18 patients were taking various SSRIs. Median S100B value was 151.7 pg/mL (minimum-maximum: 120.4-164.7 pg/mL) in the control group, 147.4 pg/mL (minimum-maximum: 138.8-154.1 pg/mL) in the drug free group and 153.0 pg/mL (minimum-maximum: 137.9-164.7 pg/mL) in the treatment group. Kruskal-Wallis analysis showed a significant diffrerence among the three groups (z=9.9, df=2, p=0.007). Follow up Mann-Whitney-U tests indicated that while the control and the patients with treatment were not significantly different (z=-0.05, p=0.96), there were significant differences between the control group and untreated patients (z=-2.6, p=0.009) and treated and untreated patients (z=-3.0, p=0.003). CONCLUSION: Our results suggested that, serum S100B protein level might be decreased in untreated PD patients and that patients who were treated with SSRIs had similar S100B level to healthy controls.

Effect of cyprodinil and fludioxonil pesticides on bovine liver catalase activity.

This study investigated if the use of the pesticides cyprodinil and fludioxonil produced an inhibitory effect on the bovine liver catalase (CAT) activity. It was documented that the activity of the enzyme decreased with increasing concentrations of cyprodinil and fludioxonil from 0 to 500 ppm. At pesticide concentrations of 250 and 500 ppm, the activity of CAT remained unchanged and passed to a steady state. The exposure to cyprodinil in concentrations of 10, 50, 100, 250 and 500 ppm, led to a decrease in the per cent of the CAT enzyme activity calculated as 45.4, 68.0, 73.0, 77.8 and 77.4, respectively. Similarly, the exposure to fludioxonil in concentrations of 10, 50, 100, 250 and 500 ppm, produced the following percentage decrease in the CAT enzyme activity: 20.0, 30.8, 42.8, 46.3 and 45.9, respectively. Cyprodinil inhibited CAT competitively, whereas the mechanism of fludioxonil inhibition over the enzyme was non-competitive.

The validity and reliability of the Turkish version of the bipolar depression rating scale.

INTRODUCTION: Unipolar depression and bipolar depression differ in their clinical presentations, and the conventional depression rating scales fail to capture these differences. Recently, a new scale to rate the severity of depression in bipolar disorder was developed, and this study aims to evaluate the validity and reliability of this scale in a Turkish clinical sample. METHODS: A total of 81 patients (30 males, 51 females) diagnosed with bipolar depression according to the DSM-IV-TR criteria at three different sites in Turkey were interviewed with the Bipolar Depression Rating Scale (BDRS), the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Positive and Negative Syndrome Scale Depression and Excitement subscales. Internal consistency, interrater reliability and concurrent validity of the BDRS were evaluated. RESULTS: The Turkish version of the BDRS had an acceptable internal consistency (Cronbach's alpha=0.786). Moderate to strong correlations between the BDRS, and the MADRS (r=0.808), and the PANSS-D (r=0.426) were observed, and the BDRS correlated weakly to moderately with the PANSS-E (r=0.297), and the YMRS (r=0.368). The mixed symptom cluster score of the BDRS significantly correlated with the YMRS (r=0.755), and the PANSS-E (r=0.712). Exploratory factor analysis showed a three-factor solution. These factors corresponded to somatic depression, psychological depression, and mixed symptoms. CONCLUSIONS: This study shows that the Turkish version of the BDRS is a valid and reliable instrument to measure depressive symptomatology in bipolar disorder. The scale has good internal validity, strong interrater reliability, and moderate to strong correlations with other depression rating scales.

Identifying gene-environment interactions in schizophrenia: contemporary challenges for integrated, large-scale investigations.

Recent years have seen considerable progress in epidemiological and molecular genetic research into environmental and genetic factors in schizophrenia, but methodological uncertainties remain with regard to validating environmental exposures, and the population risk conferred by individual molecular genetic variants is small. There are now also a limited number of studies that have investigated molecular genetic candidate gene-environment interactions (G × E), however, so far, thorough replication of findings is rare and G × E research still faces several conceptual and methodological challenges. In this article, we aim to review these recent developments and illustrate how integrated, large-scale investigations may overcome contemporary challenges in G × E research, drawing on the example of a large, international, multi-center study into the identification and translational application of G × E in schizophrenia. While such investigations are now well underway, new challenges emerge for G × E research from late-breaking evidence that genetic variation and environmental exposures are, to a significant degree, shared across a range of psychiatric disorders, with potential overlap in phenotype.

Use of oxidative stress biomarkers in Cyprinus carpio L. for the evaluation of water pollution in Ataturk Dam Lake (Adiyaman, Turkey).

Adiyaman city, which is located in the north of the Ataturk Dam Lake, has no wastewater purification facilities which results in municipal, agricultural, and industrial wastewater discharges directly entering the reservoir. To assess the pollution in the dam lake, we used several oxidative stress biomarkers in blood tissue of Cyprinus carpio. Fish samples were taken from Sitilce, polluted area by untreated wastewaters, and Samsat, relatively clean area, in the reservoir in August 2012. The activity of catalase and level of malondialdehyde increased while activity of superoxide dismutase and glutathione level decreased in fish from Sitilce site when compared to Samsat site. The findings of the present investigation suggest that the presence of certain prooxidative compounds that can lead to oxidative stress in the fish at the Sitilce site and oxidative stress biomarkers may be important in order to evaluate the effects of untreated wastewaters on living organisms in the dam lake.

Does spinal anesthesia increase the pain and anxiety after total knee arthroplasty? a randomized prospective study.

OBJECTIVES: In this study, postoperative pain and anxiety level of the patients who were scheduled for spinal anesthesia (SA) and remained awake during the operation and patients who were scheduled for general anesthesia (GA) and were asleep during the operation were assessed. PATIENTS AND METHODS: Thirty-six patients who underwent total knee arthroplasty in our clinic were randomly divided into two groups. The first group (SA group) was given spinal anesthesia during operation (heavy marcaine), while the second group (GA group) underwent general anesthesia (propofol + nitric oxide). Hospital anxiety-depression (HAD) scores and visual analog scale (VAS) scores of the patients were calculated postoperatively. The patients were asked to score anxiety by the physicians. RESULTS: The mean postoperative HAD score was 24.68 in GA group, and 29.62 in SA group (p>0.05). The physicians score for patients' anxiety after surgery was 1.05 in GA group, and 1.69 in SA group (p<0.05). The mean postoperative VAS of the patients was 8.42 in GA group, and 8.87 in SA group (p>0.05). No statistically significant differences were found between the SA group and GA group in terms of HAD scores. No significant differences were found between the mean postoperative VAS scores of the groups. A statistically significant difference was found between the two groups for the physician's score for patients' postoperative anxiety. CONCLUSION: Our study results showed that total knee arthroplasty under spinal anesthesia was not associated with mood changes in patients and no increase in postoperative pain was seen.

Effects of zinc and ferritin levels on parent and teacher reported symptom scores in attention deficit hyperactivity disorder.

OBJECTIVE: It has been suggested that both low iron and zinc levels might be associated with Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, the association of zinc and iron levels with ADHD symptoms has not been investigated at the same time in a single sample. METHOD: 118 subjects with ADHD (age = 7-14 years, mean = 9.8, median = 10) were included in the study. The relationship between age, gender, ferritin, zinc, hemoglobin, mean corpuscular volume and reticulosite distribution width and behavioral symptoms of children and adolescents with ADHD were investigated with multiple linear regression analysis. RESULTS: Results showed that subjects with lower zinc level had higher Conners Parent Rating Scale (CPRS) Total, Conduct Problems and Anxiety scores, indicating more severe problems. CPRS Hyperactivity score was associated both with zinc and ferritin levels. Conners Teacher Rating Scale (CTRS) scores were not significantly associated with zinc or ferritin levels. CONCLUSIONS: Results indicated that both low zinc and ferritin levels were associated with higher hyperactivity symptoms. Zinc level was also associated with anxiety and conduct problems. Since both zinc and iron are associated with dopamine metabolism, it can be speculated that low zinc and iron levels might be associated with more significant impairment in dopaminergic transmission in subjects with ADHD.