Short-term effects of three continuous hormone replacement therapy regimens on platelet tritiated imipramine binding and mood scores: a prospective randomized trial.

OBJECTIVE: To evaluate the effects of continuous hormone replacement therapy (HRT) regimens on platelet-tritiated ((3)H-) imipramine binding (Bmax) and mood. DESIGN: Prospective randomized study. SETTING: University hospital. PATIENT(S): Sixty postmenopausal patients. INTERVENTION(S): Randomization to 3 months of daily treatment with tibolone and conjugated equine estrogen (CEE).625 mg combined either with 2.5 or 5 mg of medroxyprogesterone acetate (MPA). The inclusion criteria-matched patients declined for HRT were prescribed daily alendronate. Pre- and posttreatment blood sampling for Bmax and mood evaluation with the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were done. MAIN OUTCOME MEASURE(S): Pre- and posttreatment Bmax and mood scores. RESULT(S): As compared with baseline, both CEE+MPA regimens and tibolone significantly increased Bmax. The comparisons of percent change from baseline Bmax for the CEE+MPA and tibolone groups were similar. All three HRT regimens improved the BDI significantly, while there were no significant changes in the STAI. In the alendronate group, there were no significant changes in both pre- and posttreatment Bmax and mood scores. CONCLUSION(S): Continuous treatment with CEE+MPA and tibolone increases platelet (3)H-imipramine binding and improves mood. Mood-enhancing effects of tibolone may occur through the serotonergic system, as is the case with estrogen.

Test-retest reliability of the alcohol and drug use disorder sections of the schedules for clinical assessment in neuropsychiatry (SCAN).

This report presents the results of a test-retest reliability study of the alcohol and drug dependence, as well as harmful use/abuse were investigated in Ankara, Turkey and Farmington, Connecticut (US). Reliabilities for the past year, prior to past year, and lifetime diagnosis of alcohol and drug use disorders were evaluated using ICD-IO, DSM-III-R and DSM-IV criteria. The results indicate that SCAN alcohol and drug diagnosis have good to excellent levels of reliability for dependence across different substances, different diagnostic systems, and different cultural groups. Diagnostic classification of alcohol and drug abuse/harmful use was considerably less reliable. Implications of the findings are discussed.

Clinical and personality correlates of outcome in depressive disorders in a Turkish sample.

Effects of clinical and personality traits on the course of depression were investigated after a mean period of 30 months. 66 out of 119 depressive patients (according to DSM-III-R and ICD-10 diagnostic criteria) were re-assessed by the same clinicians of the index episode. Schedule for Standardized Assessment of Depressive Disorders (SADD) was the main instrument for the initial phase; the follow-up schedule of SADD was used for the second phase. In both phases personality was evaluated by Eysenck Personality Questionnaire (EPQ). Severity of the disorder was assessed by Beck Depression Inventory. We found a chronicity rate of 9.1%, recurrence rate of 31.8%. Common features of chronic depressives were female sex, being over 30 years of age, gradual and late onset, presence of anxiety and multiple life events. EPQ results of the subjects who were free of depression were compared at the follow-up assessment. The remitted recurrent depression group showed significantly lower neuroticism scores than remitted single depression group. Neurotic depression subgroup was significantly associated with higher neuroticism scores.

Religiosity and religious obsessions in obsessive-compulsive disorder.

Religion has often been thought to play a part in the genesis of some cases of obsessive-compulsive disorder (OCD). In this study, we explored the relationship between religiosity, religious obsessions, and other clinical characteristics of OCD. Forty-five outpatients with OCD were evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Yale-Brown Obsessive-Compulsive Checklist (Y-BOCC) as well as the Religious Practices Index (RPI), which was developed for this study. On the basis of these evaluations, 42% of the patients were found to have religious obsessions. Despite differences in the frequency of religious obsessions found in this study compared with others, a factor analysis revealed the symptom dimensions to be similar to those found in other OCD samples. There was no significant difference in the overall severity of obsessions and compulsions between patients with and without religious obsessions. RPI scores did not differ significantly between groups. We failed to find a relationship between RPI scores or religious obsessions and any particular type of obsession or compulsion. A logistic regression analysis revealed that the sole predictor of the presence of religious obsessions was a higher number of types of obsessions. In conclusion, we failed to find a conclusive relationship between religiosity and any other clinical feature of OCD, including the presence of religious obsessions. On the other hand, we showed that the patients who tend to have a variety of obsessions are more likely also to have religious obsessions. Thus, religion appears to be one more arena where OCD expresses itself, rather than being a determinant of the disorder.

Psychiatric morbidity, quality of life, and disability in mesial temporal lobe epilepsy patients before and after anterior temporal lobectomy.

Considerable interest has been focused on the psychiatric complications of medically refractory temporal lobe epilepsy (TLE) before and after epilepsy surgery. The aim of the present study was to evaluate the psychiatric status, quality of life, and level of disability in medically refractory mesial temporal lobe epilepsy (MTLE) patients, a homogenous subgroup of patients with TLE, before and after anterior temporal lobectomy (ATL). The study population consisted of 22 patients with medically refractory MTLE who were candidates for ATL. Patients were examined before surgery as well as in the third and sixth months of the postoperative period. Psychiatric diagnosis was determined by using SCID-I. To rate the severity of psychiatric disorders, BPRS, HDRS, and HARS were employed on each visit. WHO-DAS-II and WHOQOL-BREF were used to determine the level of disability and quality of life. Preoperatively, six patients had a psychiatric diagnosis. Three months after surgery, six of the patients had psychiatric diagnoses. Five of these six patients had not been previously diagnosed. There was no significant difference between preoperative and postoperative follow-up evaluations in terms of HDRS, HARS, and BPRS ratings. With respect to the total scores and domains of WHO-DAS-II, the change in pre- and postoperative evaluations was statistically significant only for the social life attendance domain. There was no significant difference in the mean scores on the WHOQOL-BREF domains or on the first question about general evaluation of quality of life. For the second question on the level of satisfaction with health, the difference between the three ratings was statistically significant. Preoperative and postoperative rates of psychiatric disorders in our sample were low. While social phobia was frequently seen preoperatively, the postoperative period was spearheaded by major depressive disorder. The decrease in disability in attendance to social life and improvement in the quality of health were in concordance with the literature, indicating the positive results of surgical treatment of epilepsy on quality of life. This study suggests that surgical intervention might be one of the causes of postoperative psychiatric disorders in patients with MTLE.

The influence of neurocognitive deficits and symptoms on disability in schizophrenia.

OBJECTIVE: The purpose of the present study was to examine the relationship of disability with neurocognitive deficits and symptoms in schizophrenia. METHOD: Sixty patients with schizophrenia and 30 healthy controls matched for age, sex and level of education were included in the study. Neurocognitive tests measuring attention, visual memory and executive functions were given. Severity of symptomatology was assessed by the Positive and Negative Syndrome Scale (PANSS). Disability level of the subjects was assessed by World Health Organisation-Disability Assessment Schedule 2 (WHO-DAS-2). RESULTS: PANSS total score and the subscores were all correlated with DAS scores at a significant level. Neurocognitive test scores were not significantly associated with disability level. Regression analysis furthermore showed that symptom severity was predictive of the disability level. CONCLUSION: These results suggest that, rather than neurocognitive deficits, symptoms appear to have direct impact on the functioning of patients with schizophrenia in many domains of life.

Yale-Brown Obsessive Compulsive Scale and US National Institute of Mental Health Global Obsessive Compulsive Scale in Turkish: reliability and validity.

Fifteen patients with DSM-III-R diagnosis of obsessive-compulsive disorder (OCD) were rated according to the Turkish version of the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the US National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH-GOCS) by 7 raters independently from audiotaped interviews. Patients also completed the Maudsley Obsessive Compulsive Inventory (MOCI). Interrater reliability of Y-BOCS and NIMH-GOCS were very good as well as correlations between these two scales. The correlations of MOCI with Y-BOCS and NIMH-GOCS were not significant. We found Y-BOCS and NIMH-GOCS to be reliable and valid instruments in assessing the severity of OCD. These findings suggest that MOCI may not be a suitable instrument for assessing the severity of OCD.