White matter characteristics in the early and late stages of bipolar disorder: A diffusion tensor imaging study.

BACKGROUND: Bipolar disorder (BD) is characterized by recurrent mood episodes that may progress over time. Staging models may be used to follow the long-term course of BD. BD is associated with microstructural changes in white matter (WM). This study aims to compare the WM integrity within patients groups who are in different stages of BD and healthy controls and investigate whether WM integrity changes may be a biomarker that can be used in the clinical staging of BD. METHODS: The study sample included euthymic 54 patients diagnosed with BD according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and 27 healthy volunteers. Early-stage patients (n = 26) were determined as patients who have not had any mood episodes after the first manic episode, and late-stage patients (n = 28) determined as patients with recurrent mood episodes. MRI was performed using a 1.5 Tesla MR system and DTI sequences were acquired. RESULTS: Region of interest (ROI) analyses showed that late-stage patients had significantly reduced fractional anisotropy (FA) in the right sagittal stratum and genu of the corpus callosum compared with healthy controls and early-stage patients. Regression models show that corpus callosum genu and right sagittal stratum FA values are predictive for the late-stage patient group. LIMITATIONS: There are some limitations of the ROI method. The cross-sectional design is another limitation of this study. CONCLUSIONS: WM integrity of corpus callosum genu and right sagittal stratum may be a biomarker for clinical staging of BD. Identifying stage-specific biomarkers may help us predict the neuroprogressive course of BD. Longitudinal studies would be required to detect stage-specific biomarkers.

Ganglion cell complex thickness changes in patients with different states of bipolar disorder.

OBJECTIVES: Neuroimaging studies in patients with bipolar disorder have suggested that a neuropathological process may be effective in this disease. Neurodegenerative changes in the retina can be followed by optical coherence tomography, a non-invasive imaging method that allows in vivo visualization of the retinal layers. The aim of this study was to investigate the possible differences in optical coherence tomography parameters during euthymic, manic, and depressive episodes in patients diagnosed with bipolar disorder. METHODS: A total of 150 patients with bipolar disorder were included in the study, divided into three groups (50 patients in a euthymic state, 50 patients in a manic state, and 50 patients in a depressive state) and compared with 50 healthy controls. Ganglion cell complex thickness was measured with automated macular segmentation software of spectral-domain optical coherence tomography. RESULTS: Ganglion cell complex thicknesses were thicker in all quadrants in patient groups than the control group but the differences were significant in perifoveal superior and perifoveal inferior quadrants (p < 0.001, p < 0.001). There were no differences in ganglion cell complex thickness among the patient groups (p > 0.05). CONCLUSION: The evaluation of ganglion cell complex thickness by spectral-domain optical coherence tomography may give a clue for monitoring neurodegenerative changes in patients with bipolar disorder.

Delirium After Pregabalin Withdrawal.

Pregabalin is a γ-amino butyric acid analogue drug that is used in fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, spinal cord injury, and postherpetic neuralgia. Symptoms reported in association with pregabalin withdrawal include insomnia, gastrointestinal distress, tachycardia, and headache. This case report describes a 68-year-old patient who developed delirium after experiencing pregabalin withdrawal. Clinicians should be aware of the possibility of pregabalin withdrawal delirium.

The effects of adding long-acting injectable antipsychotic drugs to clozapine on relapse and hospitalization in patients with treatment-resistant schizophrenia: a mirror-image retrospective study.

The literature assessing the addition of long-acting injectable antipsychotics (LAIs) to clozapine is limited. The aim of this retrospective study was to determine the safety and effectiveness of adding LAIs to clozapine in patients with treatment-resistant schizophrenia (TRS). Patients aged 18-65 years with TRS, who were treated with first-generation (FGA-LAIs) and second-generation (SGA-LAIs) for at least 1 year after clozapine use, were included retrospectively by registration system scanning. Effectiveness measures included relapses and hospitalizations and days of hospitalization. Safety outcomes included levels of neutrophils, fasting blood sugar, total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and prolactin. The data of 29 patients who met the study criteria were evaluated. The numbers and days of hospitalizations and the numbers of relapses significantly decreased after LAI addition. Comparisons of the neutrophil counts and the total cholesterol, triglyceride, HDL, LDL, prolactin, and fasting blood glucose levels as safety indicators of the clozapine and LAI combination revealed no statistically significant change in these values before and after LAI addition. Adding LAIs to clozapine is apparently well tolerated in patients with TRS and may have a positive effect on the course of the disease.

Impact of initiating long-acting injectable paliperidone palmitate on relapse and hospitalization in patients with bipolar I disorder: A mirror image retrospective study.

Literature assessing the use of long-acting injectable paliperidone palmitate in patients with bipolar I disorder is limited. The aim of this retrospective study was to determine the effectiveness of long-acting injectable paliperidone palmitate treatment on relapse and hospitalization in a real-world setting. Patients with bipolar I disorder aged 18-65 years, who were treated with paliperidone palmitate once-monthly (PP1M) for at least one year, were included. The rate of relapse, hospitalization, and length of hospital stay were collected. Safety outcomes included levels of prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein. The data of 36 patients who met the study criteria were evaluated. Number and length of hospitalizations, number of manic and mixed episodes significantly decreased after PP1M addition. When we compared the prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein levels as an indicator of the safety of treatment, there was no statistically significant change in these values before and after PP1M addition. Our findings suggested PP1M may be effective in reducing manic and mixed episodes. Limitations include a mirror image retrospective design and small sample size.

Assessment of depressive symptoms, self-esteem, and eating psychopathology after laparoscopic sleeve gastrectomy: 1-year follow-up and comparison with healthy controls.

PURPOSE: The aim of this study was to assess depressive symptoms, self-esteem, and eating psychopathology in bariatric surgery patients at the preoperative period (t0) and at the 6-month (t1) and 12-month (t2) follow-ups after laparoscopic sleeve gastrectomy (LSG). A second aim was to investigate associations between these variables and weight loss. METHOD: The study participants were 48 bariatric surgery candidates and 50 non-obese controls. Both groups underwent assessment with the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Eating Disorder Examination Questionnaire (EDE-Q), and Rosenberg Self-esteem Scale (RSES). These assessments were repeated for the patient group at t1 and t2. RESULTS: The HDRS, RSES, and EDE-Q scores were higher in the patients before LSG (t0) than in the control group. A significant progressive improvement was identified in the patient HDRS and RSES scores as well as EDE-Q weight and shape subscale scores at t1 and t2. However, the patient EDE-Q total and dietary restraint scores improved at t1 then stabilized. The patient EDE-Q eating concern subscale improved at t1, but then worsened. The patient HDRS scores at t2 were similar to the control group, but the EDE-Q and RSES scores were still higher than the control scores at t2. Regression analyses revealed no association between the preoperative scores and percent changes in postoperative scores for any scale and patient weight loss at t2. CONCLUSION: Depressive symptoms, self-esteem, and eating psychopathology showed an improving trend in patients after LSG. However, some aspects of eating psychopathology worsened despite an initial improvement. LEVEL OF EVIDENCE: III, prospective cohort and case-control study.

Affective temperaments in caregiver of patients with bipolar disorder and their relation to caregiver burden.

BACKGROUND: Bipolar disorder (BD) is impose a severe burden on caregivers. The aspects of the burden should be evaluated from broad perspective, because caregivers contribute greatly to the treatment process. Affective temperaments are widely distributed in the population, in their mild forms can provide adaptive properties. The aim of this study was to assess the affective temperaments among caregiver of patients with BD and to evaluate the impact of affective temperaments on the burden. METHODS: The study sample included 101 caregivers of patients diagnosed with BD type I according to DSM-5 and 107 healthy volunteers. The Temperament Evaluation of the Memphis, Pisa, Paris and San Diego self-report questionnaire (TEMPS-A), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS) were administered to both groups, and the Burden Assessment Scale (BAS) was administered to caregivers. RESULTS: The hyperthymic and depressive temperament scores were higher in the caregivers than in the controls, and hyperthymic and depressive temperaments were predictor factors for caregiver. Irritable temperament also adversely affected the caregiver burden, but hyperthymic temperament was not related to development of burden. The mean BAS score was 43.2 ±â€¯11 for the caregivers. The caregiver HDRS and HARS scores and the number of manic episodes were related to the level of burden. LIMITATION: Cross-sectional study CONCLUSION: Affective temperaments may be related to being a caregiver and to the caregiver burden. Hyperthymic and depressive temperaments may indicate predisposition for being a caregiver. Irritable temperament adversely affects burden, whereas hyperthymic temperament could protect the caregiver from burden.

Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder.

Background: Currently, increasing evidence supports the hypothesis that alterations in the immune-inflammatory system are critical for the pathophysiology of bipolar disorder (BD). Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and mean platelet volume (MPV) have recently been investigated as inexpensive and simple inflammatory markers. Aims: The aim of this study is to compare NLR, PLR, MLR, and MPV in depressive, manic, and euthymic patients with BD and healthy controls, and to evaluate whether values of NLR, PLR, MLR, and MPV are possible state or trait biomarkers in BD. Methods: This retrospective study was conducted with 341 patients with BD (100 patients in a depressive state, 141 patients in a manic state, and 100 patients in a euthymic state) and 114 healthy controls. Results: We found that patients with BD in manic states had higher levels of MPV, NLR, and MLR, and patients with BD in depressive states had higher levels of MPV than the controls. Moreover, MPV predicted all states of BD, while NLR and MLR predicted the manic state of BD. Conclusions: NLR, MLR, and MPV obtained from simple and inexpensive blood tests were significantly higher in patients with BD than in healthy controls, which each imply low-grade inflammation. MPV may serve as a possible trait biomarker of BD, while NLR and MLR may both serve as possible state biomarkers of the manic state.

Chitinase-3-like protein 1 levels in bipolar disorder.

OBJECTIVES: To evaluate the relationship between the expression level and biologic role of YKL-40 in bipolar disorder (BD). METHODS: This case-control study was conducted in the Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey in 2015. One hundred and four patients diagnosed as having bipolar disorder (DSM5 criteria), and 96 participants were included as healthy controls in this study. A human YKL-40 enzyme-linked immunosorbent assay (ELISA) kit was used to measure the serum YKL-40 levels. As independent variables, we collected data on C-reactive protein (CRP), demographic variables, and medications. Results: The mean YLK-40 levels for the BD was 2723.5±543.8 pg/ml and control groups was 2132.5±576.3 pg/ml (t=7.42, p less than 0.001). The mean CRP levels for the BD was 0.4±0.6 mg/dl and control groups was 0.4±0.7 mg/dl (t=0.02, p=0.985). The receiver operating characteristics (ROC) analysis revealed an area under the curve (AUC) of YKL-40 in the diagnosis of BD as 0.79 (95% confidence interval [CI]: 0.72-0.85) with a sensitivity of 82.7% and specificity of 68.1% at a cutoff level of 2307.1 pg/ml. The use of antidepressants, antipsychotics, mood modifiers, and the presence of any comorbidity was not related to the YKL-40 levels (p greater than 0.05). Conclusion: With acceptable sensitivity and specificity levels, the YKL-40 can be utilized as a marker in the diagnosis and follow-up of BD.

Metabolic syndrome and vaspin in patients with bipolar disorder.

Metabolic disorders and abnormal levels of circulating adipokines have been reported in patients with bipolar disorder (BD). The aim of this study was to investigate the differences in the correlations of vaspin plasma levels and metabolic parameters between two groups: patients with BD and mentally healthy persons. We measured plasma levels of vaspin, metabolic parameters, and metabolic syndrome (MS) in 101 patients with BD and 90 healthy control (HC) subjects. Patients with BD were evaluated with the Young Mania Rating Scale (YMRS) to assess manic symptoms and the Hamilton Depression Scale (HDS) to assess depressive symptoms. The Global Assessment of Functioning (GAF) was used to evaluate the general functions of the patients. Body mass index (BMI), weight, waist circumference (WC), fasting glucose, and triglyceride levels of the study group were statistically higher than those of the healthy controls (p = 0.001, p < 0.001, p < 0.001, p = 0.027, and p = 0.001 respectively). Plasma levels of vaspin were 0.978 ng/ml in patients with BD and 0.292 in the HC group (p < 0.001). Our study revealed associations between metabolic parameters/metabolic syndrome and vaspin plasma concentrations in patients with BD. Vaspin can play a specific role in the pathogenesis of metabolic disorders in these subjects and can be a specific indicator substance in BD.

Dynamic thiol disulphide homeostasis in operating theater personnel exposed to anesthetic gases.

BACKGROUND: The purpose of this study was to investigate the association between dynamic thiol/disulphide homeostasis and occupational exposure to volatile anesthetic gases in operating theater personnel. Decreased blood thiol levels and raised blood disulphide levels serve as biomarkers of oxidative stress. METHODS: We included 65 subjects occupationally exposed and 55 unexposed healthy medical professionals into the study. A novel method enabled separate measurements of components involved in dynamic thiol/disulphide homeostasis (native thiol, disulphide, and total thiol). To control for the potential confounding effect on oxidative stress of psychological symptoms potentially caused by occupational stress, we used scores obtained from four different anxiety and depression inventories. RESULTS: Mean ± standard deviation native thiol was found to be 433.35 ± 30.68 in the exposed group, lower than among controls, 446.61 ± 27.8 (P = 0.02). Disulphide in the exposed group was 15.78 ± 5.12, higher than among controls, 12.14 ± 5.33 (P < 0.001). After adjusting for anxiety and depression scores, age and gender, native thiol remained lower and disulphide higher in the exposed group (P = 0.008 and P < 0.001). CONCLUSION: Dynamic thiol/disulphide homeostasis in workers exposed to anesthetic gases was found to be disturbed after adjusting for the possible contribution of anxiety. We infer that this is due to the oxidative effect of exposure to anesthetic gases.

Plasma 8-isoPGF2α and serum melatonin levels in patients with minimal cognitive impairment and Alzheimer disease.

BACKGROUND/AIM: F2α-isoprostane is accepted as an oxidative stress indicator and melatonin shows neuroprotective effects by antioxidative and antiamyloidogenic influences. By measuring these in patients diagnosed with minimal cognitive impairment (MCI) and Alzheimer-type dementia, we intended to demonstrate whether the measurement of these markers contributes to early diagnosis of Alzheimer disease (AD) in the MCI stage or not. MATERIALS AND METHODS: Three groups (n = 63) were created: the AD group, MCI group, and control group. Serum melatonin levels were measured by radioimmunoassay method, and plasma total 8-isoPGF2α levels were measured by enzyme immunoassay method. RESULTS: Significant differences were observed in the melatonin levels between the MCI group and AD group (P = 0.009), and in 8-isoPGF2α levels between the AD group and control group (P = 0.022). A negative correlation between mini-mental state examination (MMSE) scores and 8-isoPGF2a levels (r = -0.459, P < 0.001) and positive correlation between MMSE scores and melatonin levels (r = 0.317, P = 0.011) were found. CONCLUSION: Although the plasma 8-isoPGF2α and serum melatonin levels in MCI were not found to be good early diagnostic markers to indicate risk of AD, results were found to support the role of oxidative stress in AD.