Impact of obsessive-compulsive disorder comorbidity on the sociodemographic and clinical features of patients with bipolar disorder.

BACKGROUND: In this study, our aim is to determine the prevalence rates of obsessive-compulsive disorder (OCD) comorbidity and to assess the impact of OCD comorbidity on the sociodemographic and clinical features of patients with bipolar disorder (BD). METHODS: Using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version on bipolar patients, 2 groups, BD with OCD comorbidity (BD-OCD) and BD without OCD comorbidity, were formed. These groups were compared for sociodemographic and clinical variables. RESULTS: Of 214 patients with BD, 21.9% of them had obsession and/or compulsion symptoms and 16.3% had symptoms at the OCD level. Although there was no statistically significant difference between the frequency of comorbid OCD in BD-I (22/185, 11.9%) and BD-II (3/13, 23.1%) patients, but OCD was found to be significantly high in BD not otherwise specified (10/16, %62.5) patients than BD-I (P < .001) and BD-II (P = .03). Six patients (17.1%) of the BD-OCD group had chronic course (the presence of at least 1 mood disorder episode with a duration of longer than 2 years), whereas the BD without OCD group had none, which was statistically significant. There were no statistically significant differences between BD-OCD and BD without OCD groups in terms of age, sex, education, marital status, polarity, age of BD onset, presence of psychotic symptoms, presence of rapid cycling, history of suicide attempts, first episode type, and predominant episode type. LIMITATIONS: Main limitation of our study was the assessment of some variables based on retrospective recall. CONCLUSIONS: Our study confirms the high comorbidity rates for OCD in BD patients. Future studies that examine the relationship between OCD and BD using a longitudinal design may be helpful in improving our understanding of the mechanism of this association.

Parkinsonism secondary to duloxetine use: a case report.

In literature, there are more than hundred cases of extrapyramidal symptoms (EPS) associated with selective serotonin reuptake intibitors (SSRI) whereas EPS case reports associated with serotonin noradrenaline reuptake inhibitors (SNRI) are in a relatively small number. A SNRI group drug duloxetine that is used for indication of major depression since 2004 is a double acting antidepressant that acts by blocking serotonin and noradrenaline reuptake. Side effects of duloxetine on extrapyramidal system are not expected due to low affinity to D2 receptors. In this case, report manifestations of parkinsonism developed in a patient who used duloxetine for major depression are presented. Since any duloxetine induced EPS case has not reported so far, we have thought that this case can contribute to the literature.

[Aphasia, prosopagnosia and mania: a case diagnosed with right temporal variant semantic dementia]. / Afazi, Prosopagnozi ve Mani: Semantik Demans Sag Temporal Varyant Tanili Bir Olgu.

Neurologic disorders can produce "secondary" mania, and clinicians must distinguish secondary mania from bipolar disorders (BD). Patients with new and late onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. Neurologic causes of mania include strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington's disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal lobar degeneration. The term Frontotemporal Lobar Degeneration (FTLD) is suggested for neurodegenerative diseases characterized by focal degeneration such as Primer Progressive Aphasia (PPA), Frontal Lobe Dementia, PPA- Amyotrophic Lateral Sclerosis (ALS), and Corticobasal Degeneration. In this article, we report a frontotemporal dementia (FTD) case that referred with manic symptoms. The female patient was 46 years old, married, graduated from primary school, and had been admitted with complaints of hyperactivity, excessive talking, and decreased sleep for one week. She presented first with complaints that began three years ago that included the inability to remember names, recognize faces, use household appliances, and follow rules. She had also been repeating the same words and behaviors. Prosopagnosia, aphasia, and a positive family history of ALS were discussed with related index in our case.

The clinical impact of mood disorder comorbidity on obsessive-compulsive disorder.

The present study examines the effect of concomitant major depressive or bipolar disorder on clinical symptoms of patients with obsessive-compulsive disorder (OCD). Forty-nine patients classified as OCD without a mood disorder, 26 classified as OCD with bipolar disorder (OCD-BD) and 42 classified as OCD with major depressive disorder (OCD-MDD) according to DSM-IV diagnostic criteria were included in the study. The groups were compared with respect to demographic variables and scores obtained on various scales. The OCD-BD group had more symmetry/exactness obsessions and ordering/arranging compulsions, and a more episodic course of illness and had better insight compared to the other two groups. Levels of anxiety, depression, disability and obsessive-compulsive symptom severity were significantly higher in the OCDMDD group. The rate of social phobia was higher in OCD-BD patients, whereas the rates of generalized anxiety disorder and simple phobias were higher in OCDMDD group. These findings suggest that comorbidity of major depressive disorder may increase the severity of OCD symptoms. On the other hand, bipolar disorder comorbidity may constitute a subgroup which is characterized by a higher rate of episodic course and better insight.

Family attitudes toward transgendered people in Turkey: experience from a secular Islamic country.

OBJECTIVE: In Turkey, an individual with gender identity disorder is stigmatized and isolated from society. The family largely reflects and reinforces these negative views because gender crossing poses a threat to the normatively sanctioned gender classification. METHODS: We examined the acceptance of gender identity differences by the families in 47 relatives of 39 transgendered individuals who applied to a psychiatry clinic for sex reassignment. RESULTS: Half of the relatives who came to the interview were mothers. While 85.1% of the families considered themselves as secular muslims, 14.9% were very religious. They first noticed the gender identity disorder during puberty (70.2%) or prepuberty (17%). In 63.8% it was remarked that it was a shocking experience. One-third of them felt responsible for it. While 65.9% tried to change the situation by coercion, only 27.7% adopted a supportive attitude. The majority of families tried to conceal the situation from their immediate environment and one-third did not even inform their closest relatives. For half of relatives the mass media was their only source of information whereas one-third received information from doctors. Most of the families were satisfied with the treatment. Family members also reported that the conformity of the transgendered relative within the family improved. Of the family members, 40.4% accepted the transgendered identity and approved the sex reassignment surgery as a final step. CONCLUSION: Involvement of family members in the process of change for the transgendered individual is important for both the family as well as the individual concerned.

Cigarette smoking among patients with schizophrenia and bipolar disorders.

The purpose of the present study was to investigate the ratio of smokers and the relationship of cigarette smoking to clinical features in patients with schizophrenia and bipolar disorders. One hundred and forty-four patients with schizophrenia or bipolar disorder along with 114 healthy controls were evaluated. A total of 57.5% of the patients with schizophrenia, 55.1% of the bipolar patients and 47.3% of the control group were smokers. Daily cigarette consumption among the patients with schizophrenia was higher than that for the bipolar patients, and control group. Among the patients with schizophrenia who were in acute psychotic episode, Scale for the Assessment of Positive Symptoms scores of the smokers were significantly higher.