Pituitary volumes in patients with adjustment disorder.

The pituitary gland plays an important role in the stress response mechanism. Given the direct link between adjustment disorder and stress, we hypothesized that there might be changes in the pituitary gland in these patients. The study comprised a patient group of 19 individuals with adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, and 18 healthy controls. The mean pituitary gland volumes of the patient group were not statistically significantly different from those of the healthy control group (80.81 ± 1.82 mm3 in patients with adjustment disorder vs. 81.10 ± 7.04 mm3 in healthy controls, with a statistically nonsignificant difference of P > 0.05). This finding is contrary to our previous findings in anxiety-related disorders. In this regard, adjustment disorder is not similar to anxiety-related disorders in terms of pituitary gland volumes. We should also clearly state that our study is a pioneering study and that studies with large samples are needed to support our findings. The limitations of our study can be attributed to the small sample size, the utilization of a cross-sectional design, and the inclusion of patients using psychotropic drugs.

Magnetic resonance imaging histogram analysis of corpus callosum in a functional neurological disorder

Background/aim: The aim of the present study was to examine and compare the corpus callosum (CC) via histogram analysis (HA) on T1-weighted MR images of patients diagnosed with Functional Neurological Disorder (FND) and healthy controls. Materials and methods: The study group included 19 female patients diagnosed with FND, and the control group included 20 healthy subjects. All participants were scanned with a 1.5 T MR scanner. A high-resolution structural image of the entire brain was obtained with sagittal 3D spiral fast spin echo T1-weighted images. Gray level intensity, standard deviation of the histogram, entropy, uniformity, skewness, and kurtosis values were determined with texture analysis. A student's t-test was used to compare the group data. P < 0.05 was accepted as statistically significant. Results: It was determined that the mean gray level intensity, standard deviation of the histogram, entropy calculated by the maximum, median and variance and size M percentage values were higher in patients with FND. Kurtosis and size U percentages values were lower in patients with FND. Conclusion: In the present study, analysis of CC with T1-weighted MR image HA demonstrated significant differences between FND patients and healthy controls. The study findings indicated that HA is a beneficial technique for demonstrating textural variations between the CCs of patients with FND and healthy controls using MR images.

Orbito-frontal cortex and thalamus volumes in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

Background The effect of a variety of treatment modalities including psychopharmacological and cognitive behavioral therapy on the brain volumes and neurochemicals have not been investigated enough in the patients with obsessive-compulsive disorder. Therefore, in the present study, we aimed to investigate the effect of cognitive behavioral therapy on the volumes of the orbito-frontal cortex and thalamus regions which seem to be abnormal in the patients with obsessive-compulsive disorder. We hypothesized that there would be change in the volumes of the orbito-frontal cortex and thalamus. Methods Twelve patients with obsessive-compulsive disorder and same number of healthy controls were included into the study. At the beginning of the study, the volumes of the orbito-frontal cortex and thalamus were compared by using magnetic resonance imaging. In addition, volumes of these regions were measured before and after the cognitive behavioral therapy treatment in the patient group. Results The patients with obsessive-compulsive disorder had greater left and right thalamus volumes and smaller left and right orbito-frontal cortex volumes compared to those of healthy control subjects at the beginning of the study. When we compared baseline volumes of the patients with posttreatment ones, we detected that thalamus volumes significantly decreased throughout the period for both sides and that the orbito-frontal cortex volumes significantly increased throughout the period for only left side. Conclusions In summary, we found that cognitive behavioral therapy might volumetrically affect the key brain regions involved in the neuroanatomy of obsessive-compulsive disorder. However, future studies with larger sample are required.

Effects of anti-obsessional treatment on pituitary volumes in obsessive-compulsive disorder.

BACKGROUND: We aimed to examine the effct of anti-obsessional drugs on pituitary gland volumes in the patients with obsessive-compulsive disorder (OCD). SUBJECTS AND METHODS: A group of patients with OCD and of healthy controls were evaluated by using pituitary gland magnetic resonance imaging (MRI) at baseline and after twelve weeks of treatment with selective serotonin re-uptake inhibitors or clomipramine. RESULTS: Pituitary gland volumes were found to be statistically significantly smaller in the patients with OCD compared to healthy control subjects at the beginning of the study. We found that pituitary volumes significantly increased throughout twelve weeks of treatment. CONCLUSIONS: This study provides an evidence of the effect of anti-obsessional treatment on the volumes of pituitary gland in OCD patients.

1HMRS results of hippocampus in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

OBJECTIVE: In the present study, we examined the effects of cognitive behavioral therapy (CBT) on the hippocampal neurochemistry in patients with obsessive-compulsive disorder (OCD). METHODS: Twelve patients with OCD and same number of healthy controls were included into the study. Neurochemical variables of the hippocampus were measured before and after the CBT treatment in the patient group. RESULTS: At baseline, the patients with OCD had significantly lower ratio of N-acetyl-l-aspartate/choline (NAA/CHO) compared with that of healthy control subjects. When comparing pre-treatment results of the patient group with those of post-treatment ones using paired t-test, we found that NAA/CHO ratio increased from 2.47 ± 0.64 to 3.66 ± 0.88, with a statisical significance. CONCLUSIONS: The findings may implicate that CBT increases the level of NAA which is a marker of neuronal integrity.

Hippocampus and amygdala volumes are reduced in patients with schizoaffective disorder.

We aimed to examine the hippocampus and amygdala volumes in patients with schizoaffective disorder with the notion that schizoaffective disorder has strong resemblance of clinical presentation with schizophrenia and bipolar disorder and that there have been studies on regions of interest volumes in patients with schizophrenia and bipolar disorder but not in patients with schizoaffective disorder. Eighteen patients with schizoaffective disorder and nineteen healthy controls were included into the study. Hippocampus and amygdala volumes were examined by using the MRI. Both hippocampus and amygdala volumes were statistically significantly reduced in patients with schizoaffective disorder compared to those of the healthy control comparisons (p<0.001 for the hippocampus and p<0.001 for the amygdala). In summary, our findings of the present study suggest that patients with schizoaffective disorder seem to have smaller volumes of the hippocampus and amygdala regions and that our results were in accordance with those obtained both in patients with schizophrenia and bipolar disorder, considering that schizoaffective disorder might have neuroanatomic similarities with both schizophrenia and bipolar disorder. Beacuse of some limitations aforementioned especially age, it is required to replicate our present results in this patient group.

Cortical Thickness of the Orbitofrontal Cortex in Patients with Alcohol Use Disorder.

AIMS: In the present study, it was hypothesised that compared to healthy control subjects, significant differences in the cortical thickness of the orbitofrontal cortex (OFC) region of the brain, which is relevant to both impulsivity and decision making, would be identified. METHODS: The subject groups included in the study were composed of 15 individuals who met the criteria for alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 (SCID), and were admitted to the Firat University School of Medicine Department of Psychiatry or were hospitalised, and 17 healthy control comparisons were made. The volumes of and cortical thickness of the OFC were measured in the subjects. RESULTS: It was found that patients with alcohol use disorder had reduced volumes of the OFC bilaterally and a thinner cortical thickness of the same region bilaterally compared to those of the healthy control comparisons. CONCLUSIONS: Consequently, it is suggested that the OFC region of the brain appears to be statistically significantly smaller in patients with alcohol use disorder, both in terms of cortical thickness and volume, compared to healthy controls. Future research should focus on the status of these relationships longitudinally and should assess the causality of the association with the treatment response.

Pituitary Volume in Individuals with Social Anxiety Disorder.

Background: There are no volumetric magnetic resonance imaging studies on the pituitary gland in individuals with social anxiety disorder. The present study aimed to investigate pituitary volume in individuals with social anxiety disorder compared to healthy controls due to the correlation between pituitary gland volume and stress response and the hypothalamic-pituitary-adrenal axis and hypothesized that pituitary gland volume would be different in these individuals. Methods: In this study, 21 individuals with social anxiety disorder based on fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and 20 healthy controls were included. Both patient and control groups were scanned with a 1.5-Tesla General Electric (GE) Magnetic Resonance Imaging scanner. Pituitary volume was measured with the manual tracing method. Results: The statistical analysis revealed that the mean pituitary gland volume of the individuals with social anxiety disorder was significantly smaller when compared to that of healthy controls, statistically, as presented inTable 1 [594.10±104.56 mm3 for individuals with social anxiety disorder and 818.01±215.25 mm3 for healthy controls] when it was done by using the analysis of covariance controlled for age (F = 12.979, df = 1, P < .001), sex (F = 11.448, df = 1, P < .001), and total brain volume (F = 10.772, df = 1, P < .001), demonstrating that smaller pituitary volume in social anxiety disorder, when compared to healthy subjects, was an important finding independent of age, sex, or total brain volume. Conclusion: We suggest that social anxiety disorder may be associated with smaller pituitary volume, supporting the notion that anxiety itself could reduce the pituitary volume.

1HMRS in the Hippocampus of the Female Patients with Conversion Disorder.

INTRODUCTION: Previously, we found a lower NAA (N-acetyl aspartate)/CRE (creatine) ratio in conversion disorder patients, when compared to healthy controls. In this context, the present study was designed to determine the changes in hippocampal NAA, CHO (choline), and CRE values in conversion disorder female patients, which has similar symptom basement and hypothesize that the patients with conversion disorder would have also changed neurochemicals in their hippocampal regions. METHOD: Twenty female patients and healthy controls were included in the study. Proton magnetic resonance spectroscopy (1HMRS) method was used to determine the NAA/CHO, NAA/CRE, and CHO/CRE ratios. RESULTS: The data were analyzed via age-controlled General Linear Model and it was found that the ratio of NAA/CHO was significantly lower in conversion disorder female patients when compared to healthy controls. However, NAA/CRE or CHO/CRE ratios were similar for conversion disorder patients and healthy controls. CONCLUSION: It was concluded that conversion disorder female patients might have reduced NAA/CHO ratio which implicates reduced neuronal viability, possibly related to anxiety and indirectly to somatoform symptoms.

Superior Temporal Gyrus Volumes in Patients With Social Anxiety Disorder.

Objective: To determine if superior temporal gyrus volumes are altered in patients with a social anxiety disorder.Methods: Magnetic resonance imaging (MRI) was utilized to determine the superior temporal gyrus volume in 21 patients with a social anxiety disorder and 20 control subjects without a social anxiety disorder. The superior temporal gyrus volumes were measured by manual tracing method. The study was conducted between September 2019 and April 2020.Results: The mean superior temporal gyrus volume for both sides was statistically significantly smaller than that of control subjects (left side: 11.38 ± 0.85 cm3 for patients and 12.73 ± 0.86 cm3 for controls, t=-5.064, P < .001; right side: 11.42 ± 0.84 mm3 for patients and 12.92 ± 0.85 cm3 for controls, t=-5.574, P < .001). Moreover, when comparing volumetric measurements for subregions, we detected that volumes of all subregions were also statistically significantly smaller than those of healthy comparisons (for both sides of the Heschl's gyrus and planum temporale).Conclusions: The study findings suggest that patients with social anxiety disorder seem to have smaller superior temporal gyrus volumes compared to healthy control subjects, although we do not know whether these results were in accordance with functional changes of the same region.

Insula volumes are altered in patients with social anxiety disorder.

OBJECTIVE: In the present study, we aimed at examining the volumes of the insula in more pure patients with a social anxiety disorder. METHODS: We examined twenty-one patients with social anxiety disorder according to DSM-IV and twenty healthy controls. All patients and controls were applied to magnetic resonance imaging (MRI). Insula volumes were measured by using the manual tracing method in accordance with the standard anatomical atlases and related previous studies on insula volumes. RESULTS: We found that the mean posterior and anterior insula volumes for both sides of patients were statistically significantly reduced compared to those of healthy control subjects. CONCLUSION: Consequently, in the present study, we found that patients with a social anxiety disorder had reduced insula volumes compared to those of healthy control subjects. However, to get strong this finding, novel studies with a larger sample size are required.

Effect of sertindole on QTc interval in patients with schizophrenia.

Sertindole has been marketed and offered daily clinical practice only for 9 months in our country, so no data has been its QTc prolongation potential. In the present study, we performed a clinical trial to investigate the effects of sertindole on QTc in patients with schizophrenia. The study comprised 21 patients with schizophrenia. Sertindole was administered in the following dosing regime: treatment was initiated with 4 mg/day sertindole. From day 3 to day 6, the dose was increased to 8 mg/day, and up to day 9, it was raised to 12 mg/day. The protocol allowed up to dose of 20mg/day according to effectiveness and tolerability. QTc values were determined at beginning, months 3 and 6. In addition, Positive and Negative Syndrome Scale (PANSS) were scored concomitantly. At the beginning of 6-month period, the mean QTc interval of patients was 391.7+/-19.2 ms. At the end of this period, it was 402.8+/-23.8 ms. Although the mean QTc interval changing was significant throughout 6-month period, of the patients, at any evaluation point, only 1 female (451 ms) and 1 male (433 ms) had borderline prolongation at month 3 for both, without any exceeding the dangerous limits. In summary, our results suggest that sertindole is tolerable and despite dose-related QT prolongation, sertindole had not the proarrhythmic profile. Future studies with larger sample evaluating the effects of treatment are required.

Hippocampus and amygdalar volumes in patients with refractory obsessive-compulsive disorder.

Functional and structural neuroimaging studies have implicated the hippocampus-amygdala complex in the pathophysiology of obsessive-compulsive disorder (OCD), although no consensus has been established. These brain regions have not been investigated in refractory OCD patients. Volumes of the hippocampus, and amygdala were measured by magnetic resonance imaging (MRI) in a sample of 14 refractory OCD patients and 14 healthy comparison subjects. The mean left and right hippocampal and amygdala volumes of the patients were smaller than those of the healthy controls. OCD severity was not correlated with amygdala volumes but was related to the left hippocampus. Duration of illness was correlated with both hippocampus and left amygdala. Our findings suggest that hippocampus and amygdalar abnormalities can be considered in refractoriness to OCD.

P-wave dispersion in panic disorder.

BACKGROUND: P-wave dispersion (PWD) is defined as the difference between the maximum and the minimum P-wave (Pmax and Pmin, respectively) duration. Significant variation in cardiac atrial PWD has been correlated with changes in systemic autonomic tone such as during periods of anxiety. It is also known that the degree of PWD seen on 12-lead electrocardiogram (ECG) may be a predictor of susceptibility of the atrial myocardium to future atrial fibrillation (AF). Therefore, we firstly aimed to show an association between PWD and panic disorder, a state of high sympathetic tone. METHODS: PWD was measured in 40 outpatients with panic disorder and in 40 physically and mentally healthy age- and gender-matched controls. In addition, the Panic Agoraphobia Scale (PAS) and the Hamilton Depression Rating Scale (HDRS) were scored concomitantly. RESULTS: Both Pmax and Pmin were significantly higher than those of healthy controls. PWD was significantly greater in the panic disorder group than in the controls. As expected, the mean score on PAS was significantly higher for the panic disorder group than for the controls and correlated significantly with PWD. Heart rate (measured as RR intervals in milliseconds on electrocardiogram) did not differ significantly between the groups. CONCLUSIONS: The findings of the present study suggest that the disorder may be associated with an increase in PWD. This association may result from prolonged anxiety and increase in sympathetic modulation, which are main characteristics of panic disorder.

Anxiety and depression in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) mostly follows a painful, progressively disabling course, and individuals with RA experience more psychological distress than healthy individuals. The objective of the present study is to examine the prevalences of accompanying anxiety and depression in RA cases. The study included 82 RA cases and 41 age- and sex-matched healthy volunteers as the control group. Psychiatric examinations of all cases of the patient and control groups were performed according to DSM-IV criteria. Hamilton Anxiety Scale or Hamilton Depression Scale was applied to those who were found to have anxiety or depression. Total prevalence of anxiety, depression, and mixed anxiety-depressive disorder was found to be 70.8% (n=58) in the patient group and 7.3% (n=3) in the control group, and the difference was significant (p<0.001). Of the RA patients, 41.5% (n=34) was found to have depression, 13.4% (n=11) anxiety, and 15.9% (n=13) mixed anxiety-depressive disorder. The disease duration in patients with anxiety was shorter than the RA patient with depression (p<0.05). The disease duration was positively correlated with the degree of depression and negatively correlated with the degree of anxiety (r=0.341, p<0.05; r=-0.642, p<0.05, respectively). The results of our study suggest that prevalences of anxiety and mainly depression, increase in RA cases. When the clinical picture in RA cases becomes complicated with anxiety or depression, some problems at patients' adaptation and response to treatment may be possible. RA cases should be monitored for accompanying anxiety or depression during follow-up.

[Duloxetine-Induced Hypertension: A Case Report]. / Duloksetin Kullanimina Bagli Hipertansiyon: Bir Olgu Sunumu.

Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is used for diabetic neuropathic pain and fibromyalgia as well as major depressive disorder. Serotonin-norepinephrine reuptake inhibitors may lead to increased blood pressure via their noradrenergic effects in addition to their cardiovascular side effects. In this paper, we report a case with increased blood pressure after the initiation of duloxetine that recovered by discontinuation of the medication.

Orbito-frontal cortex and thalamus volumes in obsessive-compulsive disorder before and after pharmacotherapy.

In the present study, we focused on the key brain regions, OFC and thalamus, to investigate the roles of antiobsessional agents on volume changes of these brain regions after 12 weeks of anti-obsessional treatment in patients with obsessive-compulsive disorder (OCD). Fourteen patients with OCD and the same number of healthy controls were included in the study. At baseline, the volumes of the OFC and thalamus were compared by using magnetic resonance imaging (MRI) between groups. The volumes of OFC and thalamus were evaluated before and after the anti-obsessional drug treatment solely in the patient group. Our study revealed that thalamus volumes were reduced statistically significantly throughout the treatment period. However, we found that OFC volumes did not change statistically significantly throughout the treatment period. In summary, our study found that anti-obsessional drug treatment had an effect on thalamus volumes throughout the treatment period for both sides but not on OFC volumes. However, future studies with larger sample are required.

Pituitary volumes are changed in patients with conversion disorder.

Our study group previously measured pituitary volumes and found a relationship between somatoform disoders and pituitary volumes. Therefore, in conversion disorder, another somatoform disorder, we hypothesized that pituitary gland volumes would be reduced. Twenty female patients and healthy controls were recruited to the present investigation. The volumes of the pituitary gland were determined by using a 1.5 Tesla magnetic resonance scanner. We found that the pituitary gland volumes of the patients with conversion disorder were significantly smaller than those of healthy control subjects. In the patients with conversion disorder but not in the healthy control group, a significant negative correlation between the duration of illness and pituitary gland volume was determined. In summary, in the present study, we suggest that the patients with conversion disorder have smaller pituitary volumes compared to those of healthy control subjects. Further studies should confirm our data and ascertain whether volumetric alterations determined in the patients with conversion disorder can be changed with treatment or if they change over time.

Neurochemical alterations associated with borderline personality disorder.

In neuroimaging on borderline personality disorder, prior studies focused on the hippocampus and amygdala, as mentioned above. However, no study investigated whether there were neurochemical changes in the patients with borderline personality disorder. Therefore, in the present study, we aimed to investigate neurochemical change of patients diagnosed with borderline disorder and hypothesized that neurochemicals would change in the hippocampus region of these patients. Seventeen patients and the same number of healthy control subjects were analyzed by using a 1.5 Tesla GE Signa Imaging System. N-acetylaspartate (NAA), choline compounds (CHO), and creatine (CRE) values of hippocampal region were measured. The mean NAA/CRE ratio in the hippocampus region was significantly reduced in the patients with borderline personality disorder compared to that of healthy control subjects, In addition, NAA/CHO ratio of the patients with borderline personality disorder was also significantly reduced when compared to that of healthy subjects. There was no difference in the ratio of CHO/CRE. In summary, we present evidence for reduced NAA in the patients with borderline personality disorder.