Dry Eye Related to Commonly Used New Antidepressants.

Antidepressants may have an impact on the course of eye dryness. The aim of this study was to investigate the effects of commonly used new antidepressants on eye wetting. Fifty-four patients using new antidepressants and 57 controls were recruited. The Beck Depression Scale and Beck Anxiety Scale questionnaires were completed by the patients, and drug use time and dosages were recorded. The Schirmer test was performed without prior instillation of topical anesthesia to the ocular surface, and the wetting result was recorded for each eye. Escitalopram, duloxetine, and venlafaxine were used by 27, 13, and 14 patients, respectively. The Schirmer test results in the patients were significantly lower than in the controls (P < 0.001). The patients using selective serotonin reuptake inhibitors (SSRIs) displayed lower wetting measurements (≤5 mm) compared with those using serotonin-norepinephrine reuptake inhibitors, which was independent of the duration of antidepressant usage (P < 0.05). Although SSRIs do not have anticholinergic adverse effects except paroxetine, we found that both SSRIs and serotonin-norepinephrine reuptake inhibitors increased the risk for eye dryness. The lower Schirmer test results of the SSRIs may be associated with a mechanism other than the anticholinergic system. An awareness of the drugs that contribute to dry eye will allow ophthalmologists, optometrists, and other physicians to better manage patients who have this problem.

Recurrent trichobezoar due to trichophagia: a case report.

OBJECTIVE: Trichobezoar, a hair ball in the gastrointestinal tract, is usually the result of the urge to pull out one's own hair (trichotillomania) and swallow it (trichophagia). It is almost exclusively seen in young females and may cause serious medical complications. This case report will describe an adult female patient with recurrent trichobezoars. METHOD: Data for this case report was collected from peer-reviewed literature and treatment encounters by the consultation-liaison psychiatry unit; subsequent to obtaining informed consent. RESULTS: The personality characteristics, familial structure and domestic stress found in this case mirror the literature. We initiated behavioral interventions including habit reversal training and patient education in combination with pharmacologic therapy with clomipramine. CONCLUSION: Left untreated, trichophagia can cause a life-threatening emergency, requiring surgery. Recurrence of tichobezoars can be anticipated when the underlying emotional disorder is not addressed using multimodal management including psychiatric evaluation and treatment combined with surgical procedures.

Low scores on the Benton Facial Recognition Test associated with vertebrobasilar insufficiency.

BACKGROUND: Decreased posterior cerebral circulation has been observed in patients with vertebrobasilar insufficiency (VBI). Reduced cerebral perfusion may have an impact on mental performance as measured by the Benton Facial Recognition Test (BFRT). We evaluated the usefulness of BFRT in identifying cognitive decline in patients with VBI by correlating test performance with total blood flow in the vertebrobasilar system and other variables such as educational level and gender. MATERIALS AND METHODS: Thirty-three participants without dementia (mini-mental state examination; MMSE >27) and cranial magnetic resonance imaging abnormality, but with atherosclerotic risk factors were involved in the study. Nineteen subjects had a total vertebrobasilar flow volume less than 200 ml/min (Group I), and 14 subjects had a flow volume more than 200 ml/min (Group II). RESULTS: The groups were similar in regard to gender, age, and educational level. BFRT results were 19.53 ± 3.12 and 22.36 ± 2.73 for Groups I and II, respectively (p=0.01). The educational level was the main factor affecting the BFRT score in Group I (p=0.04). DISCUSSION: BFRT is clearly impaired in VBI as measured by Doppler ultrasound examination. We concluded that the test appears to adequately distinguish cognitive levels between VBI and other patients. Additionally, our results suggest that education is associated with BFRT results, and for normative purposes, gender consideration is unnecessary. Further studies are needed to investigate the association between VBI and memory dysfunction in early dementia.

Assessment of platelet indices in patients with neurodegenerative diseases: mean platelet volume was increased in patients with Parkinson's disease.

Platelets induce chronic inflammation which is a key step in atherosclerosis and may be involved in the progression of neurodegenerative diseases (NDD). We aimed to measure the mean platelet volume (MPV) and platelet count (PLC) in NDD patients. The present study was designed to investigate the platelet function by measuring MPV and PLC in NDD. A total of 182 outpatients with Alzheimer's (AD) or Parkinson's diseases (PD) were included. The control group consisted of 104 healthy subjects. Platelet count was similar between groups. MPV values of PD patients were higher than those of AD patients and controls (P < 0.001). MPV correlated negatively with Heohn and Yahr scale (HYS) score (P < 0.001). Increased MPV in patients with PD may point to a platelet dysfunction. High-grade inflammation presents with low levels of MPV as seen in PD patients with high HYS scores.

Olanzapine intoxication-related transient diabetes insipidus.

Olanzapine is a second-generation atypical antipsychotic agent approved for the treatment of psychotic disorders and mania. The effects of olanzapine intoxication include central nervous system depression, hyperthermia, myosis, tachycardia, and orthostatic hypotension. Heretofore, only one case has been reported to develop polyuria after olanzapine overdose (560 mg). We describe a case that developed diabetes insipidus following massive olanzapine ingestion and returned to normal after desmopressin treatment.

Interleukin-6 levels in tension headache patients.

OBJECTIVE: Cytokines are pain mediators in neurovascular inflammation. This study examined interleukin 6 (IL-6) levels in the serum of tension-type headache (TTH) patients, to determine if inflammation plays a role in the pathogenesis of this condition. METHODS: Serum IL-6 levels were studied in 42 patients and 37 healthy controls from the same region. Of the patients, 20 (47.6%) experiencing TTH less than 15 days per month were placed in episodic tension-type headache (ETTH) group, and 22 (52.3%) with TTH more than 15 days per month were placed in chronic tension-type headache (CTTH) group. RESULTS: The IL-6 level was significantly higher in the patients than in the controls. The IL-6 level of CTTH patients was higher than the controls (P<0.01). The IL-6 level was similar between ETTH and CTTH patients. Correlation analysis revealed a positive relationship only between age and IL-6 level in the patients. CONCLUSIONS: CTTH and ETTH patients had an elevated serum IL-6 level compared with controls. Therefore, we believe that IL-6 may be involved in pain induction or inflammatory mechanisms in TTH. Furthermore studies of the possible connection between chronicity of headaches and cytokine levels are needed.

IL-6 levels in migraine patients receiving topiramate.

There is considerable evidence suggesting that cytokines play important roles in pain and in mediating neurovascular inflammation associated with migraine headaches. Although consensus exists to recommend topiramate (TPM) for migraine prevention, the mechanism of action in this regard is unknown. We measured serum interleukin-6 (IL-6) levels in 66 migraine patients. Of these patients, 23 (34.9%) were taking TPM for migraine, and 43 (65.1%) were not. The IL-6 levels were compared with those of healthy controls without migraine, from the population living in the same region. The mean IL-6 levels in migraine patients taking TPM and patients who did not were 67.06 +/- 92.09 pg/mL and 44.09 +/- 59.19 pg/mL, respectively (P > 0.05). The IL-6 levels were higher in the patients taking TPM. The IL-6 level in the controls was 8.60 +/- 7.36 pg/mL, which was significantly lower than the patient group using TPM (P = 0.001). Our results show that, although IL-6 may be involved in pain induction or inflammatory mechanisms of migraine attacks, the serum IL-6 level was not reduced in migraine patients receiving TPM therapy. In conclusion, we found high IL-6 levels in migraine patients both with and without TPM therapy, suggesting that high IL-6 levels during pain-free periods could be a conditioning factor, making patients more vulnerable to pain attacks in chronic migraine. Further studies investigating the possible mechanism of TPM in migraine are needed.

Factors influencing treatment compliance among Turkish people at risk for stroke.

Successful management of stroke risk factors depends on adequate knowledge and self-care. The purpose of this study was to examine the factors affecting treatment compliance among people with modifiable stroke risks. We evaluated modifiable risk factors of stroke, recognition of these factors by patients, and patients' compliance with treatment in a teaching hospital. Semi-structured questionnaires were completed using face-to-face interview techniques. A majority (58.3%) of patients were aware of their risk factors for stroke. Awareness of risk factors was statistically significant for the participants carrying risk factors such as heart disease and hyperlipidemia. Compliance of the participants with treatment was mainly affected by the recognition that their disease could be a risk factor for stroke. Awareness of the presence of multiple risk factors and nonsmoker status were positively associated with treatment compliance. Editors' Strategic Implications: The authors provide evidence that the recognition of risk factors and informative healthcare education may decrease the likelihood of and the recurrence of stroke. Future research should document efforts to inform high risk patients and measure their compliance with recommendations.