Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers' Depression on Caregiver Burden.

OBJECTIVE: We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers' depression, on the caregiver burden. METHOD: One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI). RESULTS: Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD (P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs (P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores (P < .05). CONCLUSIONS: The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.

Major Depression in Long-Term Oxygen Therapy Dependent Chronic Obstructive Pulmonary Disease.

PURPOSE: We aimed to investigate the frequency of major depression (MD) in long-term oxygen therapy (LTOT) dependent chronic obstructive pulmonary disease (COPD) patients and the effect of depression on patients' compliance with the treatment. DESIGN AND METHODS: Fifty-four consecutive patients were enrolled in the study and diagnosed as stage 4 COPD according to Global Initiative for Chronic Obstructive Lung Disease guideline. MD was diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. FINDINGS: Thirty-four (63.0%) patients had MD. MD frequency was significantly higher in patients who were noncompliant with LTOT compared with compliant patients. PRACTICE IMPLICATIONS: MD is a common psychiatric disorder in COPD patients receiving LTOT.

Relationships of neutrophil-lymphocyte and platelet-lymphocyte ratios with the severity of major depression.

We aimed to evaluate the neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of inpatients and outpatients suffering from different levels of major depression. In total, 100 inpatients and 60 patients treated at an outpatient clinic were included the study. The presence of mood and anxiety disorders was identified with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version, and the Hamilton Depression Rating Scale was used to assess the severity of major depression (MD). Inpatients and outpatients with MD did not differ in NLR or PLR. The PLRs of patients who had severe major depression with psychotic features were higher than those of patients with other types of depression, but no differences in NLRs were detected across types of depression. The PLRs were higher in patients with severe levels of major depression with psychotic features than in other patients. This parameter may be more predictive than is NLR for assessing the prognosis of major depression.

A prospective comparative study to assess the effect of maternal smoking at 37 weeks on Doppler flow velocity waveforms as well as foetal birth weight and placental weight.

Maternal smoking is known to have adverse effects on the foetus. This study aimed to evaluate the effects of maternal smoking during pregnancy on arterial blood flow velocities in the foetal-placental-maternal circulation, and the pathophysiological relationship with placental and foetal birth weight. A total of 148 singleton pregnancies in 59 smokers and 89 non-smoking controls were examined during the 37th week of gestation. Blood flow in the maternal uterine, foetal umbilical and middle cerebral arteries was analysed with Doppler ultrasonography. Statistically significant differences in Doppler waveforms were detected in the foetal umbilical artery (UmbA) (p < 0.05), but neither in uterine nor foetal middle cerebral arteries (p > 0.05). Both infant birthweight and placental weight were significantly decreased by maternal smoking (p< 0.001 for both). Maternal smoking during pregnancy did not affect either maternal uterine or foetal middle cerebral arterial blood flow, but caused abnormal blood flow in the foetal UmbA.

Prevalence of personality disorders in patients with chronic migraine.

BACKGROUND: The present study aimed to investigate the prevalence of personality disorders (PDs) in patients with chronic migraine (CM). METHODS: This study included 105 CM patients who were diagnosed according to the criteria of the International Headache Society (IHS) and 100 healthy volunteers. PDs were diagnosed with the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, and pain severity and level of disability were assessed with the Migraine Disability Assessment (MIDAS) test. RESULTS: Of the 105 CM patients, 85 (81%) had at least one PD. PDs were more prevalent in the patient group than in the healthy control group, and the most common PDs were obsessive-compulsive (n=53, 50.5%), dependent (n=20, 19%), avoidant (n=20, 19%), and passive-aggressive (n=14, 13.3%) PDs. The MIDAS scores of the CM patients with PDs were higher than those of the CM patients without PDs. CONCLUSION: PDs, particularly obsessive-compulsive, dependent, avoidant, and passive-aggressive PDs, were frequently observed in CM patients in the present study.

Sexual dysfunction, mood, anxiety, and personality disorders in female patients with fibromyalgia.

BACKGROUND: We aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM). METHODS: This case-control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders. RESULTS: Fifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%). CONCLUSION: SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM.

Mood and anxiety disorders in patients with abnormal uterine bleeding.

OBJECTIVE: We aimed to investigate the prevalence of mood and anxiety disorders in patients with abnormal uterine bleeding (AUB) and the relationship between mood and anxiety disorders and AUB. METHOD: 96 consecutive patients with not yet classified AUB based on the PALM-COEIN classification and 94 volunteers were included in the study. Mood and anxiety disorders were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. RESULTS: Out of 96 patients, 55 (57.3%) met the criteria for at least one diagnosis of mood and anxiety disorder. The most common psychiatric disorders in patients with AUB were major depression (n=15, 15.6%), generalized anxiety disorder (n=18, 18.8%) and obsessive compulsive disorder (n=22, 22.9%), respectively. Compared with the control group, the prevalence of any psychiatric disorder (x(2)=43.52, p=0.000), any mood disorder (x(2)=10:37, p=0.001) and any anxiety disorder (Fisher's exact test, p=0.000) was higher in patients with AUB. The presence of any mood and anxiety disorder was an independent risk factor for AUB. CONCLUSION: Mood and anxiety disorders, particularly major depression, generalized anxiety disorder and obsessive-compulsive disorder were frequently observed in patients with AUB.

Electrophysiological assessment in patients with long term hypoxia.

OBJECTIVE: To evaluate visual evoked potentials (VEP) patterns in chronic obstructive pulmonary disease (COPD) patients who were compliant with supplemental oxygen treatment relative to non-compliant COPD patients. METHODS: This prospective study protocol was reviewed and approved by the local ethical committee of Selcuk University and the research was performed in the Department of Neurology, Elbistan State Hospital, Kahramanmaras, Turkey from May to October 2014. Blood gas measurements and pulmonary function tests were carried out in patients with advanced stage COPD. The VEP was assessed in both eyes in both compliant and non-compliant patients. RESULTS: The study included 43 patients; 24 (55.8%) of the patients were not in compliance with their supplemental oxygen treatment, while 19 patients (44.2%) received adequate oxygen treatment. There was no statistically significant difference between patients with regards to pulmonary function test results and blood gas measurements. The VEP latency was significantly greater in both eyes of the non-compliant patients. CONCLUSION: Previous studies have reported prolonged VEP latencies in inflammatory diseases of the central nervous system. Similar electrophysiological findings were observed in our study and we propose that this may be due to oxidative stress, and inflammation that occurs secondary to chronic ischemia.

Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation.

OBJECTIVE: We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders. METHODS: In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. RESULTS: The mean age of the study subjects (n = 209) was 45.96 ± 11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n = 25, 16.9%) and generalised anxiety disorder (n = 19, 12.8%). CONCLUSIONS: Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.

Depressive Symptoms in Patients with Obstructive Sleep Apnea.

OBJECTIVES: Different studies have investigate depressive symptom degree within sleep disordered patients with obstructive sleep apnea (OSA). However, little is known and unclear about OSA in patients with depression symptom in the literature. The purpose of this study was to investigate patients with OSA would have a higher prevalence of depression symptom relative to control patients. MATERIAL AND METHODS: 72 patients with OSA (AHI ≥ 5) and 24 control subjects (AHI < 5) were assessed for depression symptom using the Beck Depression Inventory. Participants were underwent an overnight polysomnography assessment. An apnea-hypopnea index ≥ 5 events per hour was used as diagnosis for OSA. The associations between each total score on the Beck Depressive Inventory (BDI) and polysomnographic parameters were examined by correlation analysis. RESULTS: We demonstrated that BDI scores has statistically significant correlation with the OSA in our present study according to similar previous studies (p= 0.008). Oxygen Desaturation Index (ODI) has correlated with BDI (r= 0.31). CONCLUSION: These findings show that the frequency depression symptom is higher among individuals with OSA. Patients with OSA should be screened cautiously for depressive disorders.

Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients.

BACKGROUND: A number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function. METHODS: The present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points) and MMSE (cutoff: ≤24 points) scores were compared between these two groups. RESULTS: The nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively) as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year. CONCLUSION: In the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

Burden of care and quality of life in relatives of opioid dependent male subjects.

BACKGROUND: The aim of this study was to compare the quality of life (QoL) and family burden in relatives of patients with heroin dependence with that of healthy controls. SUBJECTS AND METHODS: A total of 50 heroin dependent patients and 50 of their relatives and 50 healthy subjects and 50 of their relatives were included in the study. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I) was used to determine the heroin dependence and other Axis I psychiatric disorders. Family burden and QoL levels in the relatives were assessed with the Zarit Burden Interview (ZBI) protocol and the World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF), respectively. RESULTS: There were no significant differences in demographic characteristics between the groups. When compared with healthy controls, family members of heroin dependence patients had significantly higher ZBI scores and significantly lower all subscale scores of the WHOQOL-BREF. ZBI score was positively correlated with duration of the illness. All WHOQOL-BREF subscale scores were negatively correlated with duration of the illness. CONCLUSIONS: The study suggests that heroin dependence not only affects the lives of patients but also the lives of their family members. Heroin dependence leads to high burden on the family and also impairs the QoL of relatives.

Obsessive-compulsive disorder concurrent with Melkersson-Rosenthal Syndrome: a case report.

OBJECTIVE: To describe a case of obsessive-compulsive disorder (OCD) comorbid with Melkersson-Rosenthal Syndrome (MRS). METHODS: We present a case study of comorbid OCD and MRS in a 13-year-old girl. RESULTS: She admitted to doubt obsessions and a control compulsion. The patient history included frequent facial palsy attacks, and she took prednisolone during each attack. She had her first such attack at 5 years of age, and she had suffered five attacks since then, the last one occurring 2 months before her presentation. Her obsessions began 1 week after the last attack. She was diagnosed MRS and concurrent OCD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. She was started on 20 mg/day fluoxetine. The control compulsion subsided during the second month of therapy, and the doubt obsessions improved significantly. CONCLUSION: Considering that the etiologies of MRS and childhood-onset OCD have been attributed to infectious agents and autoimmune events, we conclude that both causes may play an important role in the etiology of these conditions.

Sertraline-induced periorbital purpura: a case report.

OBJECTIVE: The incidence of mild to severe levels of spontaneous bleeding due to the usage of selective serotonin reuptake inhibitors (SSRIs) is relatively low. Although the exact mechanism is not known, it is thought that inhibition of the serotonin transporter together with a decrease in platelet serotonin could be responsible for the bleeding. Therefore, the use of SSRIs in conjunction with anti-aggregants may predispose to or exacerbate the risk of bleeding. In this case report, we describe a 44-year-old female patient with a diagnosis of anxiety disorder who spontaneously developed periorbital purpura during treatment with sertraline. CONCLUSION: Abnormal bleeding after treatment with an SSRI should be kept in mind, and alternative non-SSRI drugs of choice in such cases would be more appropriate. More extensive and comprehensive studies focusing on hemostasis and bleeding disorders are needed for SSRIs such as sertraline.

Quality of life in rheumatological patients: The impact of personality disorders.

OBJECTIVE: Rheumatological diseases are associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently observed in these patients. This study examined the impact of personality disorders on the QoL of patients with rheumatological diseases. METHOD: The study sample consisted of 142 participants including patients suffering from rheumatological disease with a personality disorder (n = 30), without any personality disorder (n = 112), and healthy control participants without physical or psychiatric disorders (n = 60). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) were used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief. RESULTS: The subscale scores of physical health, psychological health, and social relationships were significantly lower in patients with rheumatological disease regardless of the existence of personality disorder compared with the control participants. Rheumatological patients with a personality disorder had significantly lower subscale scores of psychological health (p = 0.003) and social relationships (p < 0.003) compared with patients without any personality disorder. CONCLUSIONS: Personality disorders seem to be a relevant factor that maybe associated with QoL in patients suffering from rheumatological disease.

Pregnancy-Onset Panic Disorder: Incidence, Comorbidity and Associated Factors.

INTRODUCTION: The present study aimed to investigate the incidence rate of pregnancy-onset panic disorder (POPD) among Turkish pregnant women using a diagnostic interview. Additionally, we examined whether the independent socio-demographic or clinical risk factors were associated with the risk of panic disorder in these women. METHODS: The study sample comprised 1475 consecutive pregnant women who presented to the obstetric outpatient clinics of two research centers. The rate of POPD in these participants was 1.3% (Group 1, n=20). The 20 women with POPD were compared with 250 pregnant women without pregnancy-onset depression or anxiety (Group 2; controls). Panic disorder and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. RESULTS: The incidence rate of panic disorder was 1.3% (n=20). In group 1, 55% (n=11) of the women with POPD had an additional mood or anxiety disorder. In addition, the prevalence rate of any cluster C personality disorder, including avoidant, passive-aggressive and obsessive-compulsive personality disorders, were significantly greater in the group 1 women with POPD than the control pregnant women without a panic disorder (group 2). CONCLUSION: The women with POPD were more likely than the controls to have a cluster C Axis II disorder and a history of a pre-existing anxiety or mood disorder.

Bupropion XL-induced motor and vocal tics.

Tics are stereotypical repetitive involuntary movements (motor tics) or sounds (vocal tics). Although the emergence of tics were reported in a few cases with the use of selective serotonin reuptake inhibitors, there was no case with bupropion extended-release (Bupropion XL). The current case report presents a male patient developing motor and vocal tics with the use of bupropion XL.

The roles of BDNF, S100B, and oxidative stress in interferon-induced depression and the effect of antidepressant treatment in patients with chronic viral hepatitis: a prospective study.

OBJECTIVE: The aim of the study was to research the relationship between interferon (IFN) induced depression and sociodemographic characteristics, neurotrophic factors and oxidative stress. METHODS: Sixty four cases, 34 with Chronic Hepatitis B (CHB) and 30 with Chronic Hepatitis C (CHC), were included in the study. The patients were assessed with Structured Clinical Interview for DSM-IV (SCID-I), Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS) at baseline on the 2nd and 6th weeks of treatment. S100 calcium binding protein B (S100B), brain-derived neurotrophic factor (BDNF), total antioxidant status (TAS) and total oxidative stress (TOS) levels were measured at the same visits. RESULTS: In total, 20 patients were diagnosed with major depression (MD) on the sixth week. A significant relationship was found between depression developed after IFN therapy and baseline HARS scores and the type of IFN-α. When the pretreatment levels of HDRS, HARS, S100B, BDNF, TAS, and TOS were compared to those after treatment on the 2nd week, there was a significant increase in HDRS and HARS levels and a significant decrease in the levels of S100B and BDNF. No significant change was determined for TAS and TOS levels. CONCLUSIONS: Our study suggests that the pathogenesis of IFN induced depression may involve neurotrophic factors.

Mood and anxiety disorders among inpatients of a university hospital in Turkey.

OBJECTIVE: The aim of the study was to assess the prevalence of mood and anxiety disorders among inpatients and the relationship between sociodemographic factors, medical illnesses and treatments. METHODS: In the present study, we selected 650 inpatients from all clinics except psychiatry and pediatrics in a general hospital by a simple random sampling method. Based on the exclusion criteria, 57 patients were excluded. Mood and anxiety disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: Of the participants, 226 (37.5%) had a psychiatric disorder, 87 (14.4) had a mood disorder and 146 (24.2%) had an anxiety disorder. The most common specific diagnoses were not otherwise specified as anxiety disorder (9.5%), major depression (8.6%) and generalized anxiety disorder (7.6%). While the overall prevalence was highest in the hematology clinic (60.0%), it was lowest in the clinic of infectious diseases (22.7%). Logistic regression analysis indicated that the independent factors associated with psychiatric disorders were being of the female gender and a personal history of psychiatric disorders. CONCLUSIONS: In conclusion, results of the present study suggest that mood and anxiety disorders were frequently observed among inpatients, particularly in female patients and those with an individual history of psychiatric disorder. Successful treatment of these disorders may positively contribute to the course of the disease in inpatients. However, this assumption should be confirmed by further studies.

Quality of life, family burden and associated factors in relatives with obsessive-compulsive disorder.

OBJECTIVE: The aim of this study is to assess the quality of life (QoL), family burden and psychiatric disorders in first-degree relatives of patients with obsessive-compulsive disorder (OCD) and to compare them with healthy controls and their relatives. METHODS: Forty patients with OCD and 47 of their first-degree relatives as well as 40 healthy subjects and 45 of their first-degree relatives were recruited in this study. OCD and comorbid anxiety or mood disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition Personality Disorders. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale, and the disability of patients with OCD was evaluated with the WHO DAS II. Family burden and QoL in the relatives were evaluated with the Zarit Burden Interview (ZBI) protocol and the World Health Organization Quality of Life Assessment-Brief, respectively. RESULTS: The mean ZBI score of family members of OCD patients was higher than the control relatives. Linear regression analysis indicated that the independent factors associated with ZBI were duration of OCD, comorbid major depressive disorder and poorer insight. Compared with those of control relatives, the QoL of relatives of patients with OCD was significantly lower in all domains. While the diagnosis of major depressive disorder in relatives of OCD patients was significantly higher than the control relatives, the diagnosis of any anxiety disorder did not differ. CONCLUSIONS: Our study provides evidence that OCD not only affects the lives of patients but also their family members.