Evaluation of Catatonia with Different Assessment Scales in Psychiatry and Neurology. / Psikiyatri ve Nörolojide Katatoninin Farkli Ölçeklerle Degerlendirilmesi.

OBJECTIVE: Catatonia is a syndrome that can be missed in clinical settings. Diagnosis of catatonia is important because the condition can be reversible and is associated with severe complications. This study aims to screen patients with catatonia admitted to a university hospital's psychiatry and neurology services, examine their characteristics, and compare the coverage of different catatonia scales. METHOD: During a consecutive 20 months study period, the Turkish adaptations of the Bush-Francis Catatonia Rating and the KANNER scales were administered in psychiatry and neurology inpatient units and patients on the waiting list for psychiatric hospitalization. The participants were also evaluated with DSM-5 criteria. In addition, the sociodemographic and clinical characteristics of the patients in the psychiatric group were compared. RESULTS: A total of 214 patients were evaluated. Twenty-eight (13.1%) screened positive for catatonia, and 23 (82.1%) were diagnosed with catatonia according to DSM-5 criteria. KANNER and Bush- Francis identified the same patients as having catatonia. In addition to schizophrenia and mood disorders; neurodevelopmental disorder, encephalitis, postpartum psychosis, obsessive-compulsive disorder, delirium, cerebrovascular disease, functional neurological symptom disorder have also been found to be associated with catatonia. The most common complication was urinary tract infection. Life-threatening complications were also observed. CONCLUSION: Overlooking catatonia may have dire consequences. Adhering solely to the DSM-5 criteria may miss some patients with catatonia. Widely and efficiently using standardized catatonia scales can improve detection capacity and enhance the management of morbidity and mortality.

Turkish Adaptation, Validity and Reliability Study of the Bush Francis Catatonia Rating and KANNER Scales. / Bush Francis Katatoni Degerlendirme ve KANNER Katatoni Ölçeklerinin Türkçe Uyarlama, Geçerlik ve Güvenirlik Çalismasi.

OBJECTIVE: Catatonia is a common syndrome which can be lifethreatening due to its complications. The aims of the study were to translate the Bush Francis Catatonia Rating Scale (BFCRS) and the KANNER Scale into Turkish, conduct the validity and reliability analyses and to compare the two scales. METHOD: During the study period extending over 20 consecutive months, the Turkish versions of the scales were administered to 84 patients who were hospitalized in the psychiatry ward or who were admitted to the hospitalization list. The clinical and sociodemographic characteristics of all patients were evaluated. The scales were administered to the patients by two raters, one of whom was permanently involved. RESULTS: Convergent and criterion validities revealed a high correlation between the screening instruments of both scales and between the BFCRS total score and 2nd and 3rd part scores of the KANNER Scale. BFCRS total score of ≥6, KANNER Scale 2nd part score of ≥15, or 3rd part score of ≥1 can be used with high accuracy in diagnosing catatonia according to DSM-5. Internal consistency for both scales was found to be high (Cronbach's alpha 0.902 for BFCRS and 0.9, 0.891, 0.806 for KANNER Scale subsections). Inter-rater reliability was also high for most of the scale items (mean Kappa coefficient: 0.885 for BFCRS and 0.904 for KANNER Scale). CONCLUSION: In conclusion, the Turkish adaptations of both scales were found to be valid and reliable, showing strong psychometric properties. This study is the first validity and reliability study for the KANNER Scale.

12 Psychiatrists who Shaped Psychiatry in Turkey in the Republic's First Century. / Cumhuriyetin 100 Yilinda Türkiye'de Psikiyatriyi Sekillendiren 12 Psikiyatr.

Who are the influential figures that molded Turkish Psychiatry into what it is today? This review introduces 12 psychiatrists who shaped psychiatry in Turkey during the first century of the Republic. The article presents Rasit Tahsin, the first neuropsychiatrist who establish an academic psychiatry department in Turkey; Mazhar Osman, who had so much influence that his name became a phrase to describe the mentally ill, and still lives on with the institutions he built; Ihsan Sukru, the founder of neuropathology in Turkey, a historical figure in viral encephalitis research; Fahrettin Kerim Gokay, famous for his political career and his fight against alcohol and tobacco; Rasim Adasal, a Cretian who is a cornerstone in Ankara psychiatry and a well-known figure in Turkish society life; Abdulkadir Ozbek, who introduced psychodrama to Anatolia-his 'earth'; Leyla Zileli, who disseminated psychoanalysis from Ankara to Turkey; Orhan Ozturk, a founding figure for the Journal, the Association, and Hacettepe; Ayhan Songar, a prominent figure in society and also in state bureaucracy; Ozcan Koknel, the amiable face of psychiatry in society and a respected voice; Oguz Arkonaç, a vigorous advocate for the establishment of contemporary psychiatry with DSM III in Bakirköy and then in Turkey; and Gunsel Koptagel-Ilal, who progressed the work in the psychosomatics as one of Turkey's first female psychiatry academics. As with any list, we acknowledge that absolute consensus is not possible; we are preparing a more extensive selection to be published as a book next year. We present our selection to your liking, hoping that one or more of our colleagues reading this article will be included in the selection for the next century, reflecting our collective conscious creation of psychiatry in Turkey. Keywords: Neuropsychiatry, History, Medicine, Turkey, Psychoanalysis, Psychosomatics.

Oral Health Status of Outpatients with Schizophrenia in Ankara, Türkiye: A Descriptive Study. / Ayakta Tedavi Gören Sizofreni Hastalarinin Agiz Sagligi Durumu: Tanimlayici Bir Çalisma (Ankara-Türkiye).

OBJECTIVES: To evaluate the oral health status and denture treatment needs of a group of outpatients with schizophrenia. METHODS: One hundred and eighty-eight patients diagnosed with schizophrenia were evaluated. Socio-demographic characteristics, eating habits, alcohol consumption, smoking status, oral hygiene attitudes, medical status, medications and the data related to dental visit were obtained via structured questionnaire of 45 questions. Medication information were confirmed from hospital records. The DMFT score (the Total of decayed, missing and filled teeth), denture status, Community Periodontal Index of Treatment (CPITN) and attachment loss were recorded in accordance with the criteria defined by the WHO. RESULTS: The mean DMFT score was 11.1±8.6. Total number of teeth decreased, while the number of decayed teeth and DMFT scores increased with age (p<0.001). There was no relationship between the anticholinergic effects of antipsychotics and the teeth count, number of decayed, filled and missing teeth, and the DMFT scores. The CPITN assessment revealed that 71.6% of the patients had healthy periodontium, 7.4% exhibited gingival bleeding upon probing, and 21% had dental calculus. Psychotropic medication and tooth brushing habits were associated with CPITN scores. Male sex was associated with higher frequency of denture need (p<0.001), while no association was observed with the education level and antipsychotic use (p>0.001). CONCLUSION: Physicians and dentists have to work in coordination to maintain good oral health of patients with schizophrenia. Patients should be encouraged for regular dental check-ups and dentist should take utmost care of the oral hygiene maintenance.

Valproate, obesity and other causes of clozapine poor metabolism in the context of rapid titration may explain clozapine-induced myocarditis: A re-analysis of a Turkish case series.

INTRODUCTION: Clozapine-induced myocarditis or any clozapine-induced inflammation may be a hypersensitivity reaction due to titration that was too rapid for the patient's clozapine metabolism. Clozapine metabolism is influenced by ancestry, sex, smoking and the presence of confounders including obesity, infections, and inhibitors (e.g., valproate) causing the patient to behave as a clozapine poor metabolizer (PM). A published study in a Turkish hospital identified 1 case of clozapine-induced pancreatitis and hepatitis and 9 cases of clozapine-induced myocarditis. To explore the hypothesis that the 10 patients were clozapine PMs, their serum clozapine concentrations were investigated using concentration-to-dose (C/D) ratios and their titrations carefully reviewed. METHODS: Dividing the trough serum concentration by the dose produces the clozapine C/D ratio. The dose required to reach 350ng/ml was considered the minimum therapeutic dosage and was used to classify patients according to clozapine PM status. Titration speed was assessed. RESULTS: All 10 patients were possibly clozapine PMs (3 of them had as minimum therapeutic doses: 72, 82 or 83mg/day). Nine of the 10 patients may have behaved as clozapine PMs due to obesity and/or valproate co-prescription during titration. One also had an undiagnosed infection. Of the 10 patients, 9 had at least 1 of 3 factors: too-rapid titration in the first or second weeks, or a final dosage that was too high. CONCLUSIONS: Future studies using clozapine levels and considering the role of clozapine PM status should explore whether or not all cases of clozapine-induced inflammation could be explained by lack of individualized titration.

A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report. / Günlük Elektrokonvülzif Terapi ile Tedavi Edilen Siddetli Nöroleptik Malign Sendrom: Bir Olgu Sunumu.

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, briefpulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela. Keywords: Electroconvulsive therapy, neuroleptic malignant syndrome, bipolar disorder.

Atypical Neuroleptic Malignant Syndrome Induced by Low Dose Quetiapine in a Patient Treated with Donepezil.

Neuroleptic malignant syndrome is a rare idiosyncratic drug reaction that causes morbidity and mortality. Although muscle rigidity and fever are accepted as major symptoms, there is no consensus on the diagnostic criteria. This flexibility in diagnostic criteria allows for the diagnosis of atypical cases. Keeping in mind that neuroleptic malignant syndrome may also occur with the use of low doses of atypical antipsychotics is important for making the diagnosis quickly and reducing the risk of morbidity and mortality. In this report, we aim to present a case with atypical neuroleptic malignant syndrome associated with the use of very low dose quetiapine and discuss the risk factors that facilitate its emergence.