[The treatment of bipolar disorder during pregnancy and the postpartum period]. / Gebe ve Lohusalarda Iki Uçlu Bozuklugun Sagaltimi.

The prevalence of bipolar disorder (BD) in males and females is almost equal. The onset of BD in females typically occurs during the reproductive years, complicating its treatment. Although it was once believed that pregnancy prevents recurrence, studies have shown that recurrence is common and severe during pregnancy. On the other hand, the effects of pharmacological treatment on obstetrical outcome are not well known and some of these agents are considered teratogenic. Thus, the decision to treat pregnant patients with psychotropic agents requires solving an ethical dilemma. Risk-benefit decisions should be made while considering both the risk of relapse of BD and its morbidity, and the risk of fetal exposure to psychotropic medications. Moreover, the risk of recurrence increases dramatically in the postpartum period. It is well known that all of the psychotropic medications studied enter the breast milk. Thus, their effects on infants should be considered while prescribing for a breastfeeding mother. The aim of this review was to discuss the safety profiles of the treatment options for pregnant and breastfeeding BD patients. Firstly, each medication's effects on organ dysgenesis, neonatal toxicity, and neurobehavioral development, and their associated adverse events during pregnancy and the postpartum period are discussed, with a focus on the emerging literature. Given this background, practical suggestions on tailoring treatment in BD patients, from preconception to breastfeeding are highlighted.

[Effects of valproate on male reproductive functions]. / Valproatin erkek ureme islevleri uzerine etkisi.

Valproate is an antiepileptic commonly used in the treatment of psychiatric and neurologic diseases. Some of the most frequently seen side effects affect the gastrointestinal, neurological, and hematological systems. Its side effects on reproductive functions have not been sufficiently studied. The use of valproate by females with bipolar disorder and epilepsy may cause menstrual cycle abnormalities, polycystic ovary syndrome, and hyperandrogenism. The effects on male reproductive functions have been researched only in epileptic patients and animals, and the results have been conflicting, because reproductive function abnormalities may be independent of the use of valproate and may be due to epilepsy itself. In the first part of this review reproductive function abnormalities due to epilepsy will be discussed, independent of the use of valproate or any other antiepileptic. Then, the results of research on valproate's effects on male reproductive functions (hormonal levels and sperm parameters) will be presented, including the possible underlying mechanisms of these effects, the effect of the duration of valproate use, and whether or not the effects are reversible. In the second section we review the results of animal research, which could be beneficial in assessing the effects of valproate and epilepsy.

[The role of low-dose pramipexole in the treatment of treatment-resistant bipolar depression: a case report]. / Tedaviye Dirençli Bipolar Depresif Dönemlerin Tedavisinde Düsük Doz Pramipeksolun Yeri.

Despite a wide range of various drugs, a significant proportion of depressed bipolar patients fail to respond to the treatment strategies. Novel theraupetics for bipolar depression are needed. Preliminary studies suggest that pramipexole a dopaminergic agent that has been used in the treatment of Parkinson's disease and restless leg syndrome may have antidepressant properties in unipolar and bipolar depressed patients as well as neurotrophic properties. The optimal antidepressant daily dose of pramipexole is not known. It has been suggested to be used between 0.125 to 9.0 mg/day. In double blind placebo controlled bipolar depression treatment studies, the average daily dose of pramipexole was 1.7 mg. Manic switches have been reported with depressive subjects and with subjects without any mental disorders. We report two cases of treatment resistant bipolar depression. Despite different treatment strategies and treatment adherence, the patients did not give optimal response to the treatments and continue to experience depressive relapses. They have been treated with low dose (0.5-0.75 mg/day) pramipexole augmentation successfully. The severity and the duration of the depressive episodes were decreased. No serious adverse event has been reported with pramipexole during the maintenance treatment.

[The Effects of Lithium on Calcium and Parathormone Levels: A Cross-sectional Study with Healthy Controls]. / Lityumun Kalsiyum ve Parathormon Düzeyi Üzerine Etkisi: Saglikli Kontrollerle Karsilastirmali Kesitsel Bir Çalisma.

OBJECTIVE: Despite lithium associated hyperparathyroidism (LAH) can lead to many complications, little notice has been paid to this sideeffect. The aim of this study was to investigate the effects of lithium on calcium and parathyroid hormone levels and the relation between lithium use and thyroid diseases. METHOD: This cross-sectional study was carried out with 87 lithiumtreated patients and 65 volunteers who had a similar age and gender distribution with the lithium group. Serum levels of corrected calcium, intact parathormone, phosphorus, magnesium, alkaline phosphatase, free thyroxine, thyroid stimulating hormone, thyroid autoantibodies and creatinine were assessed, and also, thyroid and parathyroid ultrasonography was conducted. Further detailed investigations were made depending on the elevation of the initially measured calcium and/ or parathormone levels. RESULTS: Median values of serum levels of the corrected calcium and the intact parathormone were significantly higher in the lithium group. Calcium levels had a mild correlation with the duration of lithium treatment. In the first assessment, while all control individuals had values within the normal reference range, 11 lithium-treated patients had corrected calcium and/or intact parathormone levels above the normal reference levels. All of the five patients, who were diagnosed with LAH after further investigation, were also diagnosed with a thyroid disorder. CONCLUSION: These results demonstrate that lithium treatment has a relationship with calcium and parathormone levels. The 5.7% prevalence of LAH and potential life-threatening conditions associated with LAH necessitates the use of available low-cost METHODS to monitor blood calcium levels of lithium-treated patients for early diagnosis.

Executive and verbal working memory dysfunction in first-degree relatives of patients with bipolar disorder.

The authors aimed to investigate cognitive performance of first-degree relatives of probands with bipolar disorder (BD). They hypothesized that the relatives of BD patients would have impaired performance on cognitive tests of frontal-executive functions. A neuropsychological battery was administered to 34 first-degree relatives of BD probands and 25 control subjects. Relatives showed significant impairment in verbal working memory and executive function. Verbal memory and psychomotor performances of relatives were not different from control subjects. One particular component of executive function, cognitive flexibility, was associated with family history of mood episodes with psychotic features. Verbal working memory and executive function deficits may be useful endophenotypic markers of genetic vulnerability to BD.

Effectiveness and tolerability of mirtazapine and amitriptyline in alcoholic patients with co-morbid depressive disorder: a randomized, double-blind study.

OBJECTIVE: Studies indicate that serotoninergic and noradrenergic pathophysiological mechanisms may underlie both alcohol abuse/dependence and depressive disorder. The purpose of this study was to evaluate and compare the effectiveness and tolerability of two serotonergic and noradrenergic antidepressant drugs-mirtazapine and amitriptyline, for the treatment of patients with alcohol dependence co-morbid with depressive disorder in a randomized, double-blind treatment setting. METHODS: Forty-four patients were included in the study. Twenty-four patients were randomized to mirtazapine and twenty to amitriptyline groups. Thirty-six of them completed the study. The 17-item Hamilton Depression Rating Scale (HDRS), the Spielberger State-Trait Anxiety Inventory (STAI) and alcohol craving questionnaire were used at baseline and, at days 7, 14, 28, 42, and 56 to estimate the effectiveness of the antidepressant treatment. Michigan Alcoholism Screening Test (MAST) was used in the assessment of alcohol dependence. The tolerability was assessed with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU). RESULTS: There was significant improvement in HDRS and alcohol craving scores with both the drugs. However there were no statistical differences between treatment groups. Mirtazapine was tolerated better than amitriptyline treatment. CONCLUSIONS: The treatment with either mirtazapine or amitriptyline resulted with the reduction of HDRS and craving scores. The side-effect profile of mirtazapine was relatively favorable in our study.

[The role and importance of cognitive symptoms in bipolar disorder]. / Bipolar bozuklukta bilissel belirtilerin dogasi ve önemi.

OBJECTIVE: Our aim was to review evidence of the role of cognitive deficits in bipolar disorder and their relationship to other factors, such as disorder variables, treatment, additional diagnoses, genetic risk, and brain imaging findings. METHOD: Studies that examined cognitive dysfunction in bipolar disorder and its relationship to the variables of clinical, genetic, and bipolar disorder subtypes, as well as neuro-anatomical and neuro-functional evidence have been reviewed. Findings from our own studies have also been used while conducting the review. RESULTS: In bipolar disorder, deficits in executive functions, memory, and attention persist in the euthymic state. The number of episodes and the course of the disorder seem to be related to the severity of memory dysfunction and psychomotor slowness. However, symptoms of cognitive dysfunction are present at the onset of the disorder. Moreover, cognitive dysfunction has been observed in the healthy relatives of bipolar disorder patients. Cognitive dysfunction in bipolar disorder is associated with functional and possibly structural anomalies in some parts of the brain, such as the frontal and cingulate cortex. Some recent studies reported a relationship between symptoms of cognitive dysfunction and genetic variations in bipolar disorder. CONCLUSION: Today, the presence of cognitive deficits in bipolar disorder is widely accepted; however, evidence of the neurobiological and clinical correlates of cognitive symptoms is still limited. More studies are needed to investigate the relationship between cognitive dysfunction in bipolar disorder and risk. Genetic studies are just now amending our body of knowledge. There have been many conflicting results reported by brain imaging studies. Different brain imaging approaches and genetic methods should be used with more specific cognitive and social-emotional tasks for increasing our knowledge about the nature of cognitive deficit in bipolar disorder.

[Anticipation in bipolar disorder: A comparison between two generations]. / Iki uçlu bozuklukta birikme etkisi: Iki nesil arasinda bir karsilastirma.

OBJECTIVE: The genetic phenomenon of anticipation is a pattern of inheritance that includes earlier age at onset and increased severity of symptoms in succeeding generations, and is a feature of some neurodegenerative diseases. This phenomenon is suggested to occur in bipolar disorder (BP) as well. METHOD: Anticipation in children with BP type 1 (s2) (n = 31) and their parents (s1) (n = 31) not-consecutive generations-was assessed by analyzing clinical characteristics and prognoses. RESULTS: Age at onset of BP type 1 in s2 (mean: 19.3 +/- 4.2 years) occurred earlier than in s1 (mean: 29.5 +/- 10.2 years) (u = 345, P < 0.001). There was a direct negative correlation between the s1 and s2 cases (r = -0.554, P < 0.001). The total number of episodes in s1 (13.9 +/- 12.3) was greater than in s2 (8.7 +/- 7), which had a higher frequency of episodes (0.6 +/- 0.3 and 1.5 +/- 1.2) (u = 357, P < 0.001). There was a direct correlation between total episodes and the frequency of manic episodes between s1 and s2 (r = 0.312, P < 0.001 and r = 0.365, P < 0.001, respectively). We observed that 72.7% of BP type 1 parents that had episodes with psychotic features had offspring that had episodes with psychotic features. CONCLUSIONS: Results of this study show that age at onset was earlier and the frequency of episodes was greater in s2 BP type 1 cases. In addition, episodes with psychotic features might be a marker for genetic anticipation.

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls.

INTRODUCTION: Lithium has many effects on thyroid physiology. Although these side effects have been known for a long time, large sample studies of lithium-treated patients using ultrasonography are lacking. The aim of this study is to investigate the detailed thyroid morphologies, hormone levels, and antibodies of lithium-treated patients compared with healthy controls. METHODS: This cross-sectional study involved 84 lithium-treated patients with bipolar disorder and 65 gender and age similar controls who had never been exposed to lithium. Subjects between 18 and 65 years of age were eligible for the study. Venous blood samples were acquired to determine the levels of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid antibodies; also, ultrasonographic examinations of the patients' thyroid glands were performed. RESULTS: There were no statistically significant differences in smoking habits, known thyroid disease, thyroid medication use, familial thyroid disease, fT4 level, autoimmunity, thyroid nodule presence, or Hashimoto's thyroiditis between the lithium and control groups. The median TSH level and thyroid volume were significantly higher in the lithium group. In the lithium group, 14 cases (16.7%) of hypothyroidism, seven cases (8.3%) of subclinical hypothyroidism, and one case (1.2%) of subclinical hyperthyroidism were defined; in the control group, seven cases (10.8%) of hypothyroidism and two cases (3.1%) of subclinical hyperthyroidism were defined. Thyroid dysfunction, goiter, parenchymal abnormality, ultrasonographically defined thyroid abnormality, and thyroid disorder were found to be more prevalent in the lithium group. 90% of patients with goiter and 74.3% of patients with ultrasonographic pathologies were euthyroid. CONCLUSION: It is important to note that 90% of the patients with goiter were euthyroid. This indicates that monitoring by blood test alone is insufficient. The prevalence rates of 47.6% for goiter and 83.3% for ultrasonographic pathology demonstrate that ultasonographic follow-up may be useful in lithium-treated patients. To determine whether routine ultrasonographic examination is necessary, large sample prospective studies are necessary due to the limitations of this study.

Sustained attention deficits in manic and euthymic patients with bipolar disorder.

Sustained attention deficits are proposed to be both state and trait indicators of bipolar disorder. The nature of these deficits and their association with medication and symptoms is not clear yet. The aim of this study was to investigate the impairments in various components of sustained attention task in euthymic and manic patients and was to investigate the relationship between the deficits in the manic state and medication effects. The performances of 37 manic patients, 34 euthymic patients with bipolar disorder and 34 control subjects on eight scores from Conners' CPT II, reflecting three different dimensions of sustained attention were compared. Similar to some recent findings, euthymic patients had decreased target sensitivity (omission errors) and response time inconsistency. The increased false responding (commission errors), perseveration and vigilance deficits were prominent in the manic patients. These state dependent impairments could not be explained by the impact of medication. In contrast, the exacerbation of seemingly trait-related impairments in the manic state can be at least partly explained by the impact of pharmacological therapy.

The effect of antidepressant treatment on N-acetyl aspartate levels of medial frontal cortex in drug-free depressed patients.

The medial frontal cortex has been shown to modulate emotional behavior and stress responses, suggesting that the dysfunction of this region may be involved in the pathogenesis of depressive symptoms. The present study was performed to determine whether there was any effect of antidepressant treatment on the metabolite levels in the left medial frontal cortex as measured by proton magnetic resonance spectroscopy in depressed patients. Twenty patients diagnosed as having major depressive disorder according to DSM-IV and 18 healthy volunteer subjects were included in the study. Twelve of patients had their first episode and were drug-naïve. Other depressed patients were drug-free for at least 4 weeks. The severity of depression was assessed by HAM-D and Clinical Global Impression Scale-Severity (CGI-S). Single voxel, 8 cm(3), 1H MR spectra of left medial frontal cortex was acquired both before and following antidepressant treatment. The concentrations and ratios of N-acetyl aspartate (NAA), Creatine+Phosphocreatine (Cr+PCr) and Choline (Cho) were measured. Pretreatment NAA/Cr values of patients were lower than those of healthy controls, but this difference did not reach to statistically significant levels (t=1.83, df=36, p=0.07). However, antidepressant treatment had significant effect on NAA/Cr ratios (groupxtreatment interaction: F=9.93 df=1,36, p=0.03). After the treatment, NAA/Cr values of patients increased significantly compared to pretreatment values (t=3.32, df=19, p=0.004). No significant difference was observed between the post-treatment NAA/Cr values of patients and those of controls (t=1.64, df=36, p=0.19). Correlation analysis detected negative correlation between pretreatment CGI-S scores and NAA/Cr ratios (r=-0.51, p=0.02). This preliminary result suggests that there might be a possible defect in the neuronal integrity in the left medial frontal cortex (mainly left anterior cingulate cortex) of depressed patients. Antidepressant treatment with its neurotrophic effects might play a positive role in restoring the neuronal integrity. Further studies are needed to support these initial findings.

[Does menstrual cycle affect mood disorders?]. / Adet Döngüsünün Duygudurum Bozukluklari Uzerine Etkisi Var midir?

OBJECTIVE: This paper will present a review of the literature on the relationship between the menstrual cycle and mood disorders. METHOD: We performed a MEDLINE search of the Turkish and English language literature for the years 1955-2005 using the following terms: depression, bipolar disorder, premenstrual syndrome, premenstrual exacerbation, premenstrual dysphoric disorder, menstrual cycle, and suicide. Earlier reports had shown higher psychiatric admission during premenstrual period of the menstrual cycle and higher prevalence of suicide attempts during specific phase of the menstrual cycle. RESULTS: Women of reproductive age with mental disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest that for a subset of women there is a relationship between phases of the menstrual cycle and increased vulnerability for an exacerbation of ongoing mood disorders (especially major depressive episode) or the development of a new episode. The question of whether the direction of mood shifts in the course of bipolar disorder is associated with specific cycle phase has been raised, albeit with limited and inconsistent data. CONCLUSION: There are a limited number of studies to elucidate these relationships and most of them lack prospective assessments, include the small number of patients and use unreliable methods of determining menstrual-cycle phases. Additionally, many reports do not specify whether the exacerbations reflect an aggravation of the underlying mood disorder or a new subset of symptoms that occur only during certain phases of the menstrual cycle. Further studies should provide more information about the contribution of premenstrual fluctuation or worsening to increased illness severity of mood disorder and treatment resistance.

Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study.

BACKGROUND: The aims of this study were to identify the dominant affective temperamental characteristics of patients with bipolar disorder (BP) and their clinically well first-degree relatives and to compare the prevalence rates of these temperaments with those in healthy control subjects. METHODS: One hundred bipolar I probands and their 219 unaffected first-degree relatives were enrolled in the study. The control group consisted of healthy subjects without any personal or family history of bipolar disorder, matched with the age and gender of the probands and first-degree relatives. To identify the dominant affective temperaments, the Turkish version of TEMPS-A scale was used. RESULTS: At least one dominant temperament was found in 26% of the proband group, in 21.9% of the relative group, and 6.0% and 10.0% of the control groups, respectively. The most noteworthy finding was that both the probands and their relatives had significantly higher frequency of hyperthymic temperament than the controls. LIMITATIONS: Temperament had not been assessed premorbidly in the probands with bipolar disorder. CONCLUSIONS: The study supports the familial, possibly genetic, basis for the hyperthymic temperament in the genesis of bipolar I dosorder. That the cyclothymic temperament was not similarly represented, may be due to the higher specificity of the cyclothymic temperament to the bipolar II sybtype (which we did not study). More research is needed on the relevance of cyclothymic and other temperaments to the genetics of bipolar disorders selected by rigorous subtyping along the clinical spectrum of bipolarity.

[The relationship of affective temperament and clinical features in bipolar disorder]. / Bipolar Bozuklukta Mizaç Ile Klinik Ozelliklerin Iliskisi.

OBJECTIVE: The aim of the present study was to investigate the relationship between affective temperaments and clinical features in bipolar disorder. Testing the relationships between phenomenological features, course, severity of episodes, overall severity of illness and comorbid conditions would clarify the reliability and validity of affective temperamental descriptions. METHODS: One hundred patients with bipolar I disorder were recruited from consecutive admissions and evaluated when euthymic. Affective temperaments were assessed with TEMPS-A Turkish version. Information about the characteristics of each patient's illness was obtained from three main sources; interview with patient (SCID-I), interview with at least one close relative and patient records. We compared the clinical features of patients with and without a specific affective temperament. RESULTS: Similar rates of cyclothymic, hyperthymic and irritable temperaments were observed in bipolar patients. Five important findings of the present study were (1) hyperthymic temperament was more frequent in males than females; (2) manic switches were more frequent among bipolar patients with hyperthymic temperament; (3) psychotic features were more common in the irritable temperament group; (4) comorbid conditions, (mostly alcohol use disorders) were more common among bipolar patients with cyclothymic temperament; and (5) bipolar patients with irritable temperament were more likely to have a manic episode at the onset of illness. CONCLUSION: These findings suggest that affective temperaments have significant clinical implications in bipolar disorder, beyond the genetic basis and predisposing factors. There were significant differences between patients with different affective temperaments in terms of gender, type of first episode, psychotic symptoms, switch and comorbidity.

Facial emotion recognition in remitted depressed women.

Although major depressive disorder (MDD) is primarily characterized by mood symptoms, depressed patients have impairments in facial emotion recognition in many of the basic emotions (anger, fear, happiness, surprise, disgust and sadness). On the other hand, the data in remitted MDD (rMDD) patients is inconsistent and it is not clear that if those impairments persist in remission. To extend the current findings, we applied facial emotion recognition test to a group of remitted depressed women and compared to those of controls. Analyses of variance results showed a significant emotion and group interaction, and in the post hoc analyses, rMDD patients had higher accuracy rate for recognition of sadness compared to those of controls. There were no differences in the reaction time among the patients and controls across the all the basic emotions. The higher recognition rates for sad faces in rMDD patients might contribute to the impairments in social communication and the prognosis of the disease.

Valproate-associated reproductive and metabolic abnormalities: are epileptic women at greater risk than bipolar women?

OBJECTIVE: Evidence indicates that valproate (VPA) may have an adverse impact on reproductive endocrine and metabolic functions in women with epilepsy. This study explores whether the association of VPA with reproductive endocrine abnormalities is applicable to women with bipolar disorder (BD) or is unique to women with epilepsy. METHODS: Thirty female patients aged 18-40 years with a DSM-IV diagnosis of BD (15 on lithium monotherapy and 15 on VPA monotherapy or VPA in combination with lithium therapy) and 15 with idiopathic generalized epilepsy (IGE) on VPA monotherapy were evaluated for reproductive endocrine functioning and metabolic parameters. RESULTS: The menarche age, mean length of menstrual cycle and mean length of menses were not significantly different between groups. None of the bipolar patients on lithium, three (20%) of the bipolar patients on VPA and seven (47%) of the epileptic patients on VPA reported menstrual disturbances. Hirsutism scores of the epilepsy group were significantly higher than those bipolar women, regardless of treatment. Serum total testosterone levels were significantly higher in patients (both with BD and with IGE) treated with VPA than in those treated with lithium. Serum FSH levels were significantly lower and LH-to-FSH ratio was significantly higher in patients with epilepsy than in patients with BD, regardless of treatment. The weight parameters and lipid values investigated did not differ significantly between the groups. CONCLUSION: The study supports the conclusion that VPA may be associated with menstrual abnormalities and increased total testosterone levels in both bipolar and epileptic patients although women with BD did not show clinical features of hyperandrogenism (menstrual abnormalities, hirsutism and truncal obesity) as did frequently as women with epilepsy.

Low serum levels of brain-derived neurotrophic factor in patients with schizophrenia do not elevate after antipsychotic treatment.

Brain-derived neurotrophic factor (BDNF) has been suggested to be involved in the etiology of schizophrenia. There is a line of evidence that disruption of neurotrophins could play a role in the etiology of schizophrenia, and antipsychotics show their effect by altering levels of neurotrophins. The aim of this study was to evaluate the effect of antipsychotics on serum BDNF levels and their relationship with the symptoms in patients with schizophrenia. Twenty-two schizophrenia patients were enrolled in the study. The control group consisted of 22 age- and sex-matched physically and mentally healthy volunteers (7 male, 15 female). Serum BDNF levels and the positive and negative syndrome scale (PANSS) scores were recorded at baseline and after 6 weeks of treatment. Serum BDNF levels were also recorded in the control group. Schizophrenia patients who failed to meet 30% improvement in PANSS score were excluded from the study. The baseline serum BDNF levels of schizophrenia patients were lower than those of controls (t = 4.56; df = 21; p < 0.001). There was no correlation between serum BDNF levels and PANSS scores in patients with schizophrenia (p > 0.05). Although PANSS (for positive symptoms p < 0.001, for negative symptoms p < 0.001) and general psychopathology (t = 20.9; df = 22; p < 0.001) scores improved significantly after 6 weeks of antipsychotic treatment; there was no change in BDNF levels in patients' serum (p > 0.05). Our results support the view that BDNF would be associated with schizophrenia. However, we could not conclude that treatment with antipsychotics alters serum BDNF levels in patients with schizophrenia.

Selective serotonin reuptake inhibitors combined with venlafaxine in depressed patients who had partial response to venlafaxine: four cases.

One third of depressive patients show partial or no response to antidepressant treatment. With partial or nonresponders, treatment strategies are as follows: switching to another antidepressant, augmenting with other psychotropic agents, or combining antidepressants. There are no data in the literature about the positive effect of combining venlafaxine with selective serotonin reuptake inhibitors (SSRIs). In this report, the presented cases had been on at least two different classes of antidepressant medication (or combination of antidepressants) for an adequate time and dose. They showed only a partial response to high dose of venlafaxine but improved after the addition of an SSRI (sertraline, citalopram, or paroxetine) to venlafaxine. The combination treatment was well tolerated in all of the cases.

Serum nitric oxide metabolite levels and the effect of antipsychotic therapy in schizophrenia.

BACKGROUND: Recently it was proposed that nitric oxide metabolites (NO) may have a role in the pathophysiology of schizophrenia and major depressive disorders. The present study was performed to assess changes in serum nitric oxide metabolite levels in schizophrenic patients compared with healthy controls. Our secondary aim was to further evaluate the impact of psychopharmacologic treatment on circulating NO levels not assessed previously. METHODS: Serum NO levels of patients with schizophrenia (n=20) before and after 6 weeks of treatment were compared with those of healthy controls (n=20). Severity of schizophrenia and response to treatment were assessed with positive and negative symptoms of schizophrenia. NO levels were estimated by Griess method in serum samples. RESULTS: In patients with schizophrenia, pre-treatment serum NO levels were higher than those of control subjects (39.15 +/- 18.24 vs. 25.40 +/- 5.83 micromol/L, p=0.036) and also of post-treatment values (34.41 +/- 16.35 vs. 25.40 +/- 5.83 micromol/L, p=0.049), respectively. However, no significant difference was found between serum NO levels in pre- and post-treatment values. CONCLUSIONS: Our findings of increased serum NO levels in schizophrenic patients confirmed the role of NO in the pathophysiology of schizophrenia. However, we found that antipsychotic drugs do not reveal significant effects on serum levels of NO in schizophrenia in a 6-week treatment regimen. Further studies with longer therapy periods may suggest some new clues for novel treatment strategies employing antioxidants and NOS inhibitors in schizophrenia.

[Is there a relationship between mood disorders and affective temperaments?]. / Duygudurum Bozukluklari ile Mizaç Arasinda Iliski Var mi?

OBJECTIVE: The aim of this study is to investigate whether depressive (DT), hyper thymic (HT), cyclothymic (CT), irritable and anxious temperaments as identified by Turkish version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire (TEMPS-A) are characteristic to depressive or bipolar disorder (BD) and to compare underlying affective temperamental differences. METHOD: 68 patients with recurrent major depression (MD-R), 50 patients with single episode major depressive disorder (MD-S), 84 euthymic bipolar patients and 100 healthy controls were included in the study and evaluated with TEMPS-A. RESULTS: There was a gender difference between patient groups. The females were more dominant in the MD-R group. The mean age of onset of illness of bipolar patients was lower than the depressive patients and the mean duration of illness of bipolar patients was longer than those of the MD-R patients. The prevalence of the rate of any dominant affective temperament was significantly higher in the MD-R group than other study groups. The prevalence rate and scores of DT were significantly higher both in MD-R and MD-S groups (25.0% and 12.0% respectively) than the BD group (2.4%) and control subjects (3.0%). The prevalence rate and scores of CT were higher among the patients groups than the controls. None of the subjects except BD patients had HT. CONCLUSION: With the limitations of the study, it is thus reasonable to speculate that affective temperament, to a degree, determine the nature and the existence of the mood disorders.