Investigation of the Relationship between Inflammation and Oxidative Stress Markers and Treatment Response in First-Attack Major Depression Patients: A Follow-Up Study. / Ilk Atak Major Depresyon Hastalarinda Inflamasyon ve Oksidatif Stres Belirteçleri ile Tedavi Yaniti Iliskisinin Incelenmesi: Bir Izlem Çalismasi.

OBJECTIVE: There is a need to biomarkers for major depression (MD). The goals of this study are to compare serum levels of oxidative stress markers malondialdehyde (MDA) and F2-isoprostane and inflammation markers tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) between patients with first-episode MD and healthy controls, to investigate the change of these markers after treatment and to investigate the relationship between levels of these markers and treatment response. METHOD: Our study was performed in 30 first-episode MD patients and 30 healthy volunteers. During the clinical evaluation Hamilton Depression Rating Scale and Clinical Global Impression Scale were applied to the participants. Serum levels of markers were measured at the baseline and after 8 weeks of treatment. RESULTS: Compared to the control group, first-episode MD patients had significantly higher IL-6, CRP and MDA levels and lower F2- isoprostane levels. There was no difference between the groups in terms of TNF-α levels. TNF-α, IL-6, MDA and F2-isoprostane levels decreased significantly after treatment, whereas there was no significant change in CRP levels with treatment. Baseline F2-isoprostane levels were found to be significantly higher in treatment responders than nonresponders (p<0.05). CONCLUSION: In our study, it was shown that there are irregularities related to inflammatory processes and oxidative stress in MD, even in patients who had their first-episode and did not take medication, and these irregularities can be resolved after treatment. While there was a relationship between treatment response and baseline F2-isoprostane levels, there was no relationship with other biomarkers.

Evaluation of affective temperament profile and levels of depressive symptoms and anxiety in patients with restless legs syndrome.

PURPOSE: Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder associated with mood and anxiety disorders. Although affective temperaments are considered subclinical manifestations of mood disorders (MDs), to date, no previous research has explored the relationship between affective temperaments and RLS. We aimed to evaluate affective temperaments, depressive symptoms, and anxiety among newly diagnosed, drug-naive patients with RLS. Additionally, our study identified possible associations between clinical variables and affective temperaments, depressive symptoms, and anxiety profiles in this group. METHODS: The study included 74 patients with RLS and 90 healthy volunteers. All participants performed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Beck Depression Inventory, and Hamilton Anxiety Inventory. RESULTS: Temperament, depression, and anxiety scores in patients with RLS were significantly higher than those in healthy controls (p ≤ 0.05). Linear regression analysis showed that anxious temperament scores were positively related to longer disease duration (ß = 0.658, p = 0.000), whereas disease severity (as measured by the International RLS Study Group Rating Scale) (ß = 0.447, p = 0.006) and lower educational status (ß = - 0.803, p = 0.008) correlated with the anxiety profile. CONCLUSIONS: Results suggested that higher scores on the affective temperament, depression, and anxiety scales indicate subclinical MDs and psychiatric comorbidities in RLS. Therefore, exploring the predictors of mood and anxiety disorders in patients with RLS may improve treatment strategies and clinical outcomes.

Protective effect of metformin on lithium-induced nephrogenic diabetes insipidus: An experimental study in rats.

BACKGROUND: Lithium is widely used in the treatment of bipolar disorders and may lead to nephrogenic diabetes insipidus (NDI), following long-term treatment. Metformin is considered the preferred initial therapy for patients with type 2 diabetes mellitus (T2D). OBJECTIVES: To investigate the protective effect of metformin on the kidney damage caused by lithium administration. MATERIAL AND METHODS: Using an animal model of chronic lithium-induced NDI, rats were divided into 4 groups: sham, metformin, lithium, and lithium + metformin. The effects of these treatments were examined using serum electrolytes, blood and tissue total antioxidant status, total oxidant status, the oxidative stress index, urine and blood osmolality, and tissue aquaporin-2 (AQP2) levels. Additionally, histopathological changes, including congestion, hydropic swelling, tubular necrosis, tubular atrophy, and Bowman's capsule dilatation, were evaluated. The total histopathological score was obtained by summing the scores for each pathological finding. RESULTS: In the lithium group, biochemical variables indicating NDI, including sodium, chloride and blood osmolality, increased, and urine osmolality decreased, compared to the sham group. With metformin treatment, the blood osmolality decreased from 328.17 mOsm/kg to 306.33 mOsm/kg, and urine osmolality increased from 349.67 mOsm/kg to 754.50 mOsm/kg (p = 0.004 and p = 0.001, respectively). Tissue AQP2 levels decreased with lithium administration but stabilized with metformin treatment. Additionally, in comparison to the lithium group, the total histopathological score in the metformin group declined from 8.0 to 2.0 (p = 0.002). CONCLUSIONS: Metformin may help protect the kidneys from lithium-induced NDI through the AQP2 regulating effect and a reduction in oxidative stress.

Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities.

BACKGROUND: Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. OBJECTIVE: This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). METHODS: A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. RESULTS: Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. CONCLUSIONS: Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.

Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities / Factores predictivos de la calidad de vida en la epilepsia del lóbulo temporal y extratemporal: asociación con perfiles de temperamento afectivo y comorbilidades psiquiátricas

ABSTRACT Background: Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. Objective: This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). Methods: A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. Results: Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. Conclusions: Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.

RESUMEN Antecedentes: Explorar los factores asociados y predictivos que reducen la calidad de vida en la epilepsia focal produce un efecto beneficioso en las estrategias de gestión y tratamiento. Objetivo: Investigar la relación entre temperamentos afectivos, depresión, ansiedad, características de la enfermedad y calidad de vida (QOL) y explorar los predictores de QOL en pacientes con epilepsia del lóbulo temporal (TLE) y epilepsia del lóbulo extratemporal (ETLE). Métodos: Se inscribieron un total de 50 pacientes con TLE, 51 pacientes con ETLE y 70 controles. Los temperamentos afectivos se evaluaron mediante el cuestionario de autoevaluación de Temperamento de Memphis, Pisa, París y San Diego (TEMPS-A). La calidad de vida se evaluó mediante la encuesta de salud de formato corto (SF-36). También se realizó a todos los participantes el Inventario de Depresión de Beck (BDI) y el Inventario de Ansiedad de Beck (BAI). Resultados: Los pacientes con TLE y ETLE tuvieron puntuaciones significativamente más altas en todas las escalas TEMPS-A que los controles, excepto la hipertimia . En la comparación de las puntuaciones del SF-36 dentro de cada grupo, todas las subescalas fueron más bajas en los pacientes con TLE y ETLE. El análisis de regresión lineal reveló que la depresión y la ansiedad, el temperamento depresivo e irritable y la frecuencia de las convulsiones fueron predictores significativos de la calidad de vida en el TLE. Además, los pacientes con ETLE con desequilibrios de temperamento afectivo, depresión comórbida y politerapia tenían una peor calidad de vida. Conclusiones: Los temperamentos afectivos, los trastornos psiquiátricos y los factores clínicos pueden predecir el deterioro de la calidad de vida en pacientes con TLE y ETLE. Se necesitan más estudios para descubrir los predictores de la calidad de vida en varios subtipos de epilepsia.

Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features.

INTRODUCTION: "Depressive disorder with mixed features" has been included in the official classification in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Hypothesizing that difficulties in emotion regulation and affective temperament scores are higher in mixed depression comparing to pure depression, we aimed to evaluate the relationship between these phenomena and mixed symptoms. METHODS: Depressive patients diagnosed by a psychiatrist according to the DSM-5 and had not received any psychiatric treatment for the last 3 months, were included in the study. The Hamilton Rating Scale (HDRS), modified Hypomania Checklist (mHCL), Difficulties in Emotion Regulation Scale (DERS), and the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) were applied to all participants. RESULTS: Of the 63 participants, 40 (63.5%) were women. The mean age was 37.8±12.4 years while mean duration of education was 10.8±4.3 years. The proportion of mixed-depression assessed by the mHCL was 23.8% (n=15). No significant difference was found between the groups concerning gender, age, family history, age at onset of illness, the total number of episodes and temperament scores. Depressive patients with mixed features had significantly higher DERS nonacceptance subscale scores. Multiple regression analysis demonstrated that the cyclothymic temperament scale scores significantly affected the total mHCL scores. CONCLUSION: In mixed depression group, higher scores in nonacceptance subscale seems to reflect a tendency to fluctuations in the emotional reactions of a person to the stress. Association between mixed depression, DERS nonacceptance subscale and cyclothymic temperament support the spectrum view that mixed depression is placed between pure depression and bipolarity.

Evaluation of Four-Year Stability of Unspecified Psychosis.

INTRODUCTION: Unspecified psychosis, defined with the F29 code in the International Classification of Diseases (ICD) 10th version is commonly used if there is inadequate information to make the diagnosis of a specific psychotic disorder. There is a lack of data about the prevalence, incidence, diagnostic validity and stability of this diagnosis. Therefore, we aimed to evaluate the prevalence and diagnostic consistency of unspecified psychosis in the outpatient unit. METHODS: Patients diagnosed with the ICD-10 F29 code at the first visit and interviewed at least three times between January 2012-2016 in the Psychiatry Outpatient Clinic were included (n=138). Hospital records were reviewed retrospectively and data were analyzed with SPSS 19th version. RESULTS: Mean duration of follow-up was 22.8±14.7 months. The diagnoses at the final follow-up were unspecified psychosis (43%), bipolar disorders (18%), schizophrenia (11%), major depression (7%), and anxiety disorders (4%). No significant difference was found between the follow-up diagnoses in terms of age, duration of follow-up, gender, educational status and marital status. CONCLUSION: The diagnostic stability of unspecified psychosis is low compared to other psychotic disorders. Follow-up studies with larger sample sizes are required to elucidate the the low diagnostic stability of unspecified psychosis.

The role of anxious temperament in patients with allergic rhinitis.

OBJECTIVES: To evaluate the depressive and anxiety levels in allergic rhinitis (AR) and to investigate the relationship between depression and anxiety symptoms and depressive and anxious temperament features. Methods: The study design is cross-sectional. The study was conducted between January 2017 and January  2018. Patients (n=101)  diagnosed with  AR and healthy controls (n=74) were included in this study. All participants were assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire).  Results: The median BAI and BDI scores of the patients were found to be significantly higher than the control group (p=0.016 and p=0.001). In AR patients, the percentage of depressive and anxious temperaments were significantly higher than in the control group (p=0.029). Depressive temperament scores showed strong positive correlation with anxious temperament and BDI scores and a medium relationship with the BAI (r; p=0.639; p less than 0.001, p=0.671; p less than 0.001, and p=0.495; p less than 0.001, respectively). Participants with anxious temperament had 6.3-times (95% CI: 1.3-28.3) the risk for developing AR.  Conclusion: Screening of temperament traits in AR patients may allow prediction of future depression and anxiety symptoms. These temperament traits may be mediators of depression and anxiety in AR patients. Depressive and anxious temperament traits may contribute to both depression and allergy.

Relationship between functional constipation and anal-retentive behavior features.

OBJECTIVES: Constipation is the most commonly seen defecation problem related to several environmental factors. Defecation is learned in the childhood anal period in which anal characteristic features appear. Problems in the childhood anal period may affect not only characters but also defecation function. This study aimed to evaluate the relationship between constipation and anal characteristic features of participants with functional constipation. MATERIAL AND METHODS: Patients with functional constipation were included into the study according to the ROME III criteria. Patients with irritable bowel disease, slow transit constipation, outlet obstruction constipation, malignancy, and psychiatric diseases were excluded from the study. Patients filled out Personality Belief Questionnaire, Hospital Anxiety and Depression Scale, and Obsessive Belief Questionnaire. The results were compared with healthy individuals. RESULTS: A total of 47 patients with functional constipation were included in the study. Avoidant, obsessive-compulsive, antisocial, narcissistic, and paranoid personality traits were found to be higher in patients with constipation than in the control group. Perfectionism/certainty, importance and control, and hospital anxiety scores were found to be higher in patients with constipation than in the control group. CONCLUSION: Constipation may be related to several factors, such as socioeconomic environment, emotional stress, age, and diet, among others. Here, it was found that anal-retentive behavior features are prominent in functional constipation. Biofeedback, which can be regarded as psychotherapy of defecation control, can be used for treatment.

Relationship of functional constipation and anal-retentive behavior features.

OBJECTIVES: Constipation is the most commonly seen defecation problem and related with several environmental factors. Learning defecation is learned in the childhood anal period in which anal characteristic features appear. Problems in the anal period of childhood may affect not only the characters but also the defecation function. We aimed to evaluate the relationship between constipation and anal characteristic features of participants with functional constipation. MATERIAL AND METHODS: Patients with functional constipation were included in the study according to the ROME III criteria. Patients with irritable bowel disease, slow transit constipation, outlet obstruction constipation, malignancy, and psychiatric diseases were excluded from the study. Patients filled out the Personality Belief Questionnaire, Hospital Anxiety and Depression Scale, and Obsessive Belief Questionnaire. The results were compared with healthy individuals. RESULTS: A total of 47 patients with functional constipation were included in the study. The avoidant, obsessive-compulsive, antisocial, narcissistic, and paranoid personality beliefs were found to be higher in patients with constipation than in the control group. Perfectionism/certainty, importance and control, and hospital anxiety scores were found to be higher in patients with constipation than in the control group. CONCLUSION: Constipation may be related to several factors, such as socioeconomic environment, emotional stress, age, and diet, among others. Here we found that anal-retentive behavior features are prominent in functional constipation. Biofeedback, which can be regarded as psychotherapy of defecation control, can be used for treatment.

Comparing ECT data of two different inpatient clinics: propofol or thiopental?

OBJECTIVE: This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II). METHODS: Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study. RESULTS: A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others. CONCLUSIONS: The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.