Relief by electroconvulsive therapy for postsurgical delirium in malignant catatonia.

We report a 46-year-old man who was successfully treated with electroconvulsive therapy for neuroleptic malignant syndrome that developed during the course of delirium after cardiac surgery. We suggest that electroconvulsive therapy be considered as a reasonable treatment alternative for relevant cases.

A placebo-controlled study of extract of ginkgo biloba added to clozapine in patients with treatment-resistant schizophrenia.

The focus of this study was the systematic evaluation of the clinical effects of the extract of ginkgo biloba (EGb) as an adjunct to the atypical antipsychotic clozapine in the treatment of refractory schizophrenia. In a placebo-controlled study, 42 patients with chronic, treatment-resistant schizophrenia, who were maintained on optimal doses of clozapine, were administered either 120 mg/day of EGb (N=20) or placebo (N=22) for 12 weeks. Clinical evaluations with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms were completed biweekly. The use of EGb as an adjunct to clozapine was effective in decreasing negative symptoms, but not positive and overall psychopathology symptoms. EGb produced a mean 7.9+/-7.0 point reduction in the total Scale for the Assessment of Negative Symptoms score compared with a mean 1.8+/-3.5 point reduction in the placebo group (P=0.034). These preliminary data suggested that EGb was found useful for enhancing the effect of clozapine on negative symptoms in patients with treatment-resistant schizophrenia.

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors.

OBJECTIVE: To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor (SSRI) treatment. METHODS: Forty-nine outpatients in remission from major depressive disorder with SSRI treatment and experiencing treatment-emergent sexual dysfunction were invited to participate and 33 (25 women and 8 men) were included in this 8-week open-label study. All patients continued her/his current SSRI treatment (dosages unchanged) and started on mirtazapine augmentation of 15 mg/day during the first week and 30 mg/day throughout the rest of the study. The Hamilton rating scale for depression (HAM-D), the psychotropic-related sexual dysfunction questionnaire (PRSexDQ), and the Golombok and Rust Inventory of Sexual Satisfaction (GRISS) were given to all patients at baseline and at each follow-up (end of the first, second, fourth, sixth, and eight weeks). RESULTS: Mirtazapine augmentation led to significant reductions in HAM-D, PRSexDQ, and GRISS scores throughout the study especially after week 4 and 48.5% of patients (n = 16) reported that they had no overall sexual dysfunction at the end of the study. CONCLUSIONS: Mirtazapine augmentation is a good choice for the treatment of SSRI-induced sexual dysfunction, and the results are typically seen later after 4-8 weeks.

The influence of emotional distress on the outcome of in-vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatment among infertile Turkish women.

BACKGROUND: To determine whether the emotional distress of infertile Turkish women is related to social support and influences the outcome of their IVF and/or ICSI treatment. METHODS: The Beck Depression Inventory, State- Trait Anxiety Inventory, and Social Support scales were administered to 104 primary infertile Turkish women before the date of their embryo transfer. Comparisons were made between the women who became pregnant and those who did not following the embryo transfer. RESULTS: Compared to the pregnant women, the non-pregnant women had a greater number of emotional symptoms despite similar levels of social support. Also, the increased severity of depressive symptoms and higher levels of anxiety were predictive of low pregnancy rates. CONCLUSION: The pregnancy rate of infertile Turkish women was associated with emotional distress and low levels of social support were associated with increased emotional distress. Further research is needed to determine the factors and mechanisms that contribute to emotional distress in the treatment of infertility.

Pro- and anti-inflammatory cytokine balance in major depression: effect of sertraline therapy.

The specific associations between antidepressant treatment and alterations in the levels of cytokines remain to be elucidated. In this study, we aimed to explore the role of IL-2, IL-4, IL-12, TNF-alpha, TGF-beta1, and MCP-1 in major depression and to investigate the effects of sertraline therapy. Cytokine and chemokine levels were measured at the time of admission and 8 weeks after sertraline treatment. Our results suggest that the proinflammatory cytokines (IL-2, IL-12, and TNF-alpha) and MCP-1 were significantly higher, whereas anti-inflammatory cytokines IL-4 and TGF-beta1 were significantly lower in patients with major depression than those of healthy controls. It seems likely that the sertraline therapy might have exerted immunomodulatory effects through a decrease in the proinflammatory cytokine IL-12 and an increase in the anti-inflammatory cytokines IL-4 and TGF-beta1. In conclusion, our results indicate that Th1-, Th2-, and Th3-type cytokines are altered in the depressed patients and some of them might have been corrected by sertraline treatment.

Effect of dissociative experiences on drug treatment of panic disorder.

BACKGROUND AND OBJECTIVE: Dissociative experiences are widespread among patients with panic disorder and have a negative impact on cognitive-behavioural therapy. In this study we aimed to investigate whether or not dissociative experiences affect response to drug treatment for panic disorder. METHODS: Thirty-five patients, 20 women and 15 men, with a mean age of 35.4 years and a diagnosis of panic disorder, were enrolled in the study. Paroxetine 20 mg/day was administered over 6 weeks. Patients were assessed on the Dissociative Experience Scale (DES) and Panic and Agoraphobia Scale (PAS) at the commencement of therapy, and on the PAS again after therapy. RESULTS: The average DES score was determined as 30.3. Agoraphobia was identified in 34.3% of patients. DES scores were higher in patients with agoraphobia than in those without agoraphobia. Agoraphobia scores were higher in patients with high DES scores. When patients were divided into those with low DES scores (< or =30) and those with high DES scores (>30), a decrease in PAS scores with treatment was observed in both groups, but the decrease was greater in those with low DES scores (18.8 +/- 6.8 vs 5.7 +/- 5.7 in the high-DES score group; Z = 4.486, p = 0.00000053). Similarly, while a decrease in PAS scores with treatment was observed both in patients with agoraphobia (p < 0.05) and in those without agoraphobia, PAS scores decreased more in non-agoraphobic patients (16.7 +/- 7.5 vs 4.8 +/- 6.6 in patients with agoraphobia; Z = 3.799, p = 0.000047). In addition, the decrease in PAS scores was significantly correlated with baseline DES score (beta = 0.706, T = 5.727, p = 0.0000022). CONCLUSION: This study shows that dissociative experiences reduce the response to drug therapy in patients with panic disorder.

[Is there gender difference in infertile couples with no axis one psychiatric disorder in context of emotional symptoms, social support and sexual function?]. / Psikiyatrik Birinci Eksen Tanisi Almayan Infertil Ciftlerde Emosyonel Semptomlar, Sosyal Destek ve Cinsel Islev Baglaminda Cinsiyet Farki Var Mi?

OBJECTIVE: It was aimed to evaluate the levels of emotional distress, social support and sexual function of infertile couples with no psychiatric Axis-I disorder according to gender differences. METHOD: The study sample of 103 primary infertile couples with no psychiatric Axis-I disorder according to DSM-IV were given Beck Depression Inventory, State and Trait Anxiety Inventory, Inventory of Perceived Social Support and Golombok Rust Inventory of Sexual Satisfaction (GRISS). RESULTS: The sample's depressive symptom severity did not indicate clinical depression, state anxiety was within normal range, and trait anxiety was high according to the scales. Compared to men, women had more severe depressive symptoms when they were the cause of couple's infertility whether alone or with their husbands, and higher trait anxiety in all infertility groups, and more perceived social support of family whether they or their husbands are the cause of infertility. According to sexual functioning profile obtained by the subscale scores of GRISS, more frequently defined problems of sexual relationship were non-communication and non-sensuality for men and avoidance for women in all infertility groups. The emotional distress of woman and man were correlated negatively with their perceived social support and positively with their sexual functioning. CONCLUSION: It was concluded that women had more social support and emotional distress and men had more problems of sexual function, however, satisfactory social support might decrease the emotional symptoms of both genders.

The Relationship between Aggression and Serum Thyroid Hormone Level in Individuals Diagnosed with Antisocial Personality Disorder.

INTRODUCTION: Aggression is one of the leading clinical characteristics of antisocial personality disorder (APD). Studies aiming to clarify and control the biological basis of aggression are ongoing. Thyroid hormones have been indicated to play a role in the development of aggression. The aim of this study was to examine the level of aggression and serum thyroid hormone in a sample of APD and to make contributions to this field with the current findings. METHODS: The sample consisted of 96 subjects with a diagnosis of APD and 97 subjects as a control group. Structured Clinical Interview for DSM-IV Axis (SCID) 1 and 2 were used for the diagnosis, and the Buss-Perry Aggression Questionnaire was administered. Based on criminal patterns, the APD group was then divided into two subgroups: "criminal" and "noncriminal" APD groups. The day after the interview, after one night of fasting, blood was collected from the subjects between 7:00 a.m. and 9:00 a.m.. Thyroid function tests and other biochemical analyses related to the confounding variables were also administered. The study group and the control group were compared in terms of their aggression scores and thyroid hormone levels. RESULTS: The mean score of free T3 level in the criminal APD group was found to be significantly higher than that in the noncriminal APD group. APD subjects with higher free T3 levels also had higher aggression scores. In the noncriminal APD group, as serum free T3 and T4 levels increased, there was also an increment in the aggression scores. However, in the criminal APD group, there was no significant correlation between thyroid hormone levels and aggression. CONCLUSION: The findings of this study indicated that criminal and noncriminal APD groups actually show different properties.

[Psychiatric symptoms in patients treated with an Ilizarov external fixator]. / Ilizarov eksternal fiksatörü uygulanan hastalarda psikiyatrik belirtiler.

OBJECTIVES: The Ilizarov technique limits daily activities of patients and may cause psychiatric symptoms. We investigated psychiatric symptoms associated with the use of an Ilizarov circular external fixator (CEF) and the relationship between symptoms and duration of CEF application in adult patients. METHODS: The study included 40 adult male outpatients (mean age 26.4 years; range 20 to 40 years) who were treated with a CEF. The participants were administered a questionnaire on sociodemographic and clinical characteristics. Psychiatric symptoms were assessed using the Symptom Check List (SCL-90-R). Data were compared with those of a control group consisting of 30 healthy males with similar sociodemographic features. RESULTS: Significant differences were found between the patient and control groups with regard to somatization (p=0.03), interpersonal sensitivity (p=0.027), depression (p=0.003), anxiety (p=0.025), hostility (p=0.004), paranoid ideation (p=0.021), additional scale (p=0.000), and overall symptom (p=0.024) scores. There was at least one psychiatric symptom in 52.5% of the subjects treated with a CEF. Hostility, interpersonal sensitivity, sleep disturbances, obsessive-compulsive signs, and anxiety were detected in 37.5%, 35%, 32.5%, 20%, and 20%, respectively. The duration of CEF application was positively correlated with depression and interpersonal sensitivity (p=0.000), and negatively correlated with anxiety (p=0.001). CONCLUSION: Our data demonstrate that, during treatment with a CEF, psychiatric problems emerge, which warrant careful evaluation of the psychiatric condition of the patients.

Smoking and substance abuse in outpatients with schizophrenia: a 2-year follow-up study in Turkey.

BACKGROUND: This study aimed to determine the prevalence of smoking and substance abuse in outpatients with schizophrenia, and to determine the relationship between smoking status and sociodemographic/clinical characteristics of schizophrenia. METHODS: One hundred and thirty-six schizophrenic outpatients were assessed by the structured clinical interview for DSM-IV (SCID) and brief psychiatric rating scale (BPRS). Demographic and treatment variables were obtained from case records and interviews with patients and their family members. RESULTS: The frequency of smoking among schizophrenic patients was 50%. However, the rate of substance abuse was 5.2%. We found no statistically significant differences between the smoker and the non-smoker patients on the demographic variables of age, sex, marital status, and employment status. There was no significant difference between the groups on BPRS scores. However, smokers were receiving a higher daily dose of neuroleptic than non-smokers. CONCLUSION: The prevalence of smoking among schizophrenic patients was similar to the rates found in Western cultures. However, the prevalence of substance abuse was lower in Turkish patients as compared with patients in the Western population.

Quality of sexual life in men with obstructive sleep apnoea.

The study investigated the quality of sexual life of male obstructive sleep apnoea patients. Apnoea and non-apnoea participants were assessed with Golombok Rust Inventory of Sexual Satisfaction (GRISS) and Structured Clinical Interview for DSM-IV (SCID) before the sleep test. Folicule Stimulating Hormone (FSH), Luteinising Hormone (LH), prolactin, testosterone and oestrogen levels were also evaluated. The apnoea group had a higher BMI and lower LH and testosterone levels than the non-apnoea group. There were no differences between the apnoea, non-apnoea groups and within the apnoea groups (mild, moderate and high apnoea) in terms of sexual satisfaction. Although there was a change in the hormonal levels of obstructive sleep apnoea patients, the sexual life of apnoea patients was not affected at the clinical level.

Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 10-week open-label study.

INTRODUCTION: Studies investigating the aripiprazole augmentation treatment of serotonin reuptake inhibitor (SRI)-resistant obsessive-compulsive disorder (OCD) are insufficient. The aim of the present pilot study was to investigate the efficacy and tolerability of flexible doses of aripiprazole as an augmenting agent in SRI-resistant OCD patients. METHODS: OCD patients who met the criteria of this study were followed up with flexible doses of aripiprazole augmentation over a 10-week period. Effectiveness of treatment was evaluated via the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales. At the end of the 10-week follow-up period, patients who showed an improvement of ≥30% for the Y-BOCS total score from baseline were considered responders. RESULTS: Thirty patients met the study inclusion criteria; three patients did not agree to participate, and four patients dropped out of the study. The differences between baseline and scores at 10 weeks for the parameters studied were as follows: Y-BOCS scores: 32.0±6.3-24.0±8.1 (Z=4.2, P<0.05); Y-BOCS compulsion subscore: 15.0±4.2-11.5±4.3 (Z=4.01, P<0.05); Y-BOCS obsession subscore: 17.0±2.6-12.4±4.0 (Z=4.1, P<0.05); and CGI-S scores: 4.8±0.8-3.1±1.2 (Z=3.9, P<0.05). Patients showed a significant improvement over the 10-week study period; however, only seven of 23 patients (30.4%) who completed the study met the criteria determined for treatment response. CONCLUSION: Despite the limited number of cases and open-label design of this study, results support the notion that adding aripiprazole to SRIs could be a valid strategy for treatment-resistant OCD patients.

The association between serum levels of neopterin and number of depressive episodes of major depression.

BACKGROUND: There is an interaction between the immune system and the central nervous system by means of hormones, peptides, and neurotransmitters. The aims of the present study were to determine whether the serum neopterin levels in patients with major depression (MD) differ from a healthy control group and to investigate the relationship between previous MD episodes and serum neopterin levels. METHODS: Thirty patients who were admitted to the GATA Psychiatry Outpatient Clinics and were diagnosed with MD according to DSM-IV, and who agreed to participate in the study, were included in the study. Twenty-six healthy volunteers matched for age, gender, and level of education who agreed to participate in the study were served as controls. Peripheral venous blood samples were obtained from the patients and the control group for complete blood count, routine biochemistry, and the detection of serum neopterin levels. The analyses were performed in the laboratory of the GATA Department of Biochemistry. RESULTS: There was no significant difference between the MD group and the healthy controls with respect to age, level of education, smoking, and gender. Serum neopterin levels of the MD group who had experienced two or more episodes were higher than the first-episode group and the control group. Age of onset and the number of previous episodes had an independent impact on serum neopterin levels in MD patients, while smoking did not show any effect. CONCLUSION: In the present study, the neopterin levels of patients who had experienced two or more episodes were higher than the first-episode depressive group and healthy control group. It was also found that the number of previous depressive episodes and the ages of the MD cases had an independent effect on serum neopterin levels.

Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient.

Depression may relapse during pregnancy in women with a history of depression. Treatments which may be effective for mothers may be harmful to the fetus. Electroconvulsive therapy (ECT) has been widely used in patients with different medical illnesses. It is safe, and its efficacy is well established. In our example, the patient was a 34-year-old white woman who was at 13 weeks' gestation at the time of admission to our hospital. Over a 1-month period, the patient underwent a total of 13 ECTs (3 times a week) and 3 more ECTs monthly until the birth of her child. After 10th ECT, the Hamilton Depression Rating Scale score was reduced from 33 before ECT to 7. After 3 more weekly ECTs, the patient was discharged from the hospital with a Hamilton Depression Rating Scale score of 3. The patient was instructed to continue maintenance treatment with ECT sessions monthly. Except for pelvic pain and transient fetal arrhythmias, no complications were reported. Thus, acute and maintenance ECT may be the choice of treatment in severely depressed or psychotic pregnant patients.

Screening disordered eating attitudes and eating disorders in a sample of Turkish female college students.

It has been hypothesized that college women are particularly susceptible to the development and maintenance of disturbed eating behaviors. The purpose of this study was to determine the frequency of disordered eating attitudes and eating disorders in a sample of Turkish female college students. The Eating Attitudes Test was administered to a sample of 414 female college students. The subjects who had a score of 30 or higher were accepted as having disordered eating attitudes, and all of them have been examined using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for eating disorders. Of the overall sample, 17.1% of subjects were classified as having disordered eating attitudes. This subgroup of subjects was then compared with the remainder on all the other measures. The differences between students with disordered eating attitudes and those without on sociodemographic variables (except for age) were not statistically significant. The rate was 1% for eating disorders including anorexia nervosa (0.5%) and bulimia nervosa (0.5%). This study suggested that the prevalences of disordered eating attitudes and anorexia nervosa among female college students in Turkey were similar to those found in Western societies, but the rate for bulimia nervosa was lower compared with Western societies.

The effect of alexithymic features on response to antidepressant medication in patients with major depression.

There has been no follow-up study regarding the effect of alexithymic features on antidepressant treatment. This study was planned to observe whether alexithymia effects short-term treatment outcome in depression. The study included 32 alexithymic and 33 nonalexithymic outpatients with major depression. Depression was assessed on the basis of the Structured Clinical Interview for DSM-IV (SCID-I). Level of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAM-D). Alexithymia was screened using the Turkish version of Toronto Alexithymia Scale (TAS-20). All patients received 20 mg/d paroxetine for 10 weeks. Alexithymic and nonalexithymic patients were compared on the HAM-D scores, TAS-20 scores, and rate of response to antidepressant medication. The rate of responders, defined by a reduction of >50% from baseline in HAM-D total score, was 21.9% in the alexithymic group and 54.5% in the nonalexithymic group. Changes in the HAM-D scores were significantly correlated with the TAS-20 scores. TAS-20 scores dropped below 61 in only 31.2% of the alexithymic patients, and 68.8% of patients remained alexithymic. Whereas 50% of patients whose TAS-20 scores dropped below 61 responded to antidepressant medication, this rate was only 9.1% among patients who remained alexithymic. These findings indicated that the stability of alexithymic features had a negative effect on antidepressant treatment in depression.

Alexithymia in male alcoholics: study in a Turkish sample.

The prevalence of alexithymia among male alcoholic cases in a clinical sample from the Turkish population and the relationship between alexithymia and clinical characteristics of alcoholics were studied. Participants were 56 males with alcohol dependence. Alcohol dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale (TAS-20). Almost 42% of the patients with alcoholism had a score greater than 60 on the TAS-20, and were therefore considered as alexithymic. The alexithymic patients were found to have a lower level of education and poor economic status. In addition, the severity of alcoholism and duration of alcohol use has been shown to be associated with alexithymia. These results suggest that there was a strong connection between alexithymia and alcoholism. However, the prevalence of alexithymia was not different in Turkish alcoholic men compared with Western alcoholic men.

The prevalence and clinical features of body dysmorphic disorder in college students: a study in a Turkish sample.

Body dysmorphic disorder (BDD) consists of a preoccupation with an imagined or slight defect in appearance, which causes significant distress or impairment in functioning. There has been little previous research about the prevalence and clinical features of BDD in different cultures. This study aimed to find the rate and the clinical features of BDD among 420 female college students in Turkey. A self-report questionnaire was used to determine the subjects' body dissatisfactions and compulsive behaviors. BDD was diagnosed using DSM-IV criteria. In this study, 43.8% of the subjects were dissatisfied with their appearance and 4.8% of all subjects were diagnosed with BDD. Head/face area and hips were the most common areas of concern. The results of this study suggested that body dissatisfaction and BDD among Turkish college students are not rare.

Body dysmorphic disorder in patients with acne.

There is growing evidence that the prevalence of body dysmorphic disorder (BDD) is significantly higher in specially selected populations as compared to the general population. The goal of the current study was to evaluate prevalence of BDD in Turkish patients with mild acne presenting to a dermatologist for treatment. This study was the first empirical investigation of BDD in acne patients in Turkey. One hundred fifty-nine outpatients diagnosed with acne who consulted to the dermatology clinic were included in the study. The diagnosis of BDD was based on DSM-IV criteria and the Structured Clinical Interview for DSM-IV (SCID-I). A study-specific questionnaire was administered to document and investigate the demographic and clinical characteristics of the cases. Fourteen (8.8%) patients were diagnosed with BDD. Three (21.4%) patients with acne and BDD also had concomitant psychiatric diagnoses. All of the patients were psychiatric management-naive, never received any psychological or physical treatments. BDD was a common psychiatric condition in acne cases. We suggest that dermatologists should routinely explore symptoms and screen such patients for BDD.