The Use of Handwriting Changes for the Follow-up of Patients with Bipolar Disorder.

Introduction: Patients with bipolar disorder have motor skill deficiency and cognitive dysfunction. It is suggested that these deficiencies are related to the neurodevelopmental course of the disease. The aim of this study was to examine whether or not there was a change in the handwriting of patients with bipolar disorder in periods of mania and remission. Method: Two samples of handwriting and signature were taken from the cases, one on admission before treatment and one just after discharge. The first sample was taken in the period when the patients hospitalised with manic episode before medications and the second sample was taken in remission when the decision for discharge was made. The handwriting changes betwen the manic episode and the remission period were examined. Results: In the examination of the handwriting between the two periods, there was an increase in the size of the writing, pen pressure, the length of words, the spaces between words, and missing and incorrect punctuation marks in the manic episode. There were no differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose but tremor count was higher in patients using antipsychotics (p<0.05). Most of the parameters showing a change were found to be related to the Young Mania Rating Scale (YMRS) scores. Conclusion: The results of this study determined severe changes in the handwriting of patients with bipolar disorder in a period of mania. Handwriting features can be used to screen patients for discharge and can be used for prediction when a patient might switch into manic episode. Also intake YMRS scores were found as the most important feature that affect handwriting parameters in manic patients.

Association of BDNF / TrkB and NGF / TrkA Levels in Postmortem Brain with Major Depression and Suicide.

BACKGROUND: Suicide Attempts are the main complications of Major Depressive Episodes and are difficult to predict. There is still a lack of knowledge about its neurochemical aspects. There is increasing evidence that Brain-derived neurotrophic factor (BDNF) and Nerve growth factor (NGF) play a role in the pathophysiology and treatment of depression by binding and activating cognate receptors Tyrosine Kinase B (TrkB) and Tyrosie Kinase A (TrkA), respectively. This study was conducted to examine whether BDNF and / or TrkB as well as NGF and / or TrkA expression profiles were changed in the hippocampus of postmortem brain of individuals with depression who committed suicide. SUBJECTS AND METHODS: This study was conducted with the brain tissue of 61 victims who died as a result of suicide due to depression and 25 people who died due to traffic accidents. The psychiatric history of the cases was determined by the psychological autopsy method. Samples were taken from the hippocampus region of the brain at the forensic medicine institution. After storage under appropriate conditions, protein and mRNA levels of BDNF, TrkB, NGF and TrkA were determined in the genetics laboratory. RESULTS: Average age of the suicide group was 30 and the average age of the control group was 24.5. The suicide group consisted of 70.5% male and 29.5% female cases. There was no significant difference between the groups in terms of age (p=0.062) and gender (p=0.718). BDNF, NGF, TrkA and TrkB values were found to be lower in the suicide group compared to the control group and there was a significant difference between the groups (p≤0.001; p=0.001; p=0.001; p=0.011). CONCLUSION: Given the importance of BDNF and NGF and their cognate receptors in mediating physiological functions, including cell survival and synaptic plasticity, our findings regarding decreased expression of BDNF, TrkB, NGF and TrkA in both protein and mRNA levels of postmortem brains of suicide victims suggests that it may play an important role in the pathophysiological aspects of its behavior. Further studies in this context may be useful both in understanding the molecular basis of suicide and in designing therapeutic models targeting these molecular pathways.

Ghrelin and lipid levels in panic disorder before and after treatment and their relationship with agoraphobia.

BACKGROUND: We aimed to evaluate serum ghrelin (GHR) levels and lipid profile in panic disorder (PD), with and without agoraphobia, and to compare these parameters before and after treatment. SUBJECTS AND METHODS: The GHR and lipid profiles were measured in blood samples taken from 31 PD patients with agoraphobia, 22 PD patients without agoraphobia, and 53 control group subjects. 23 of the 53 patients who were prescribed 20 to 40 mg/day paroxetine had continued treatment. The 23 patients who had continued treatment were measured again at the end of twelve weeks. RESULTS: The GHR and triglyceride (TRG), total cholesterol (Total-C), low-density lipoproteins (LDL-C), and very low-density lipoproteins (VLDL-C) levels were higher in the PD with agoraphobia group than the PD without agoraphobia and control groups. The 23 patients that had continued their treatment were re-evaluated, and the serum GHR, Total-C levels, and BMI after treatment were significantly decreased, compared to the values before treatment. CONCLUSIONS: There may be a pathophysiological relationship between the GHR and lipid profiles that interact with each other in PD. In fact, this relationship was more marked in PD with agoraphobia than in PD without agoraphobia.

Analysis of manganese superoxide dismutase (MnSOD: Ala-9Val) and glutathione peroxidase (GSH-Px: Pro 197 Leu) gene polymorphisms in mood disorders.

We investigated the etiopathogenetic role of manganese superoxide dismutase (MnSOD) (Ala-9Val) and glutathione peroxidase (GSH-Px) (Pro 197 Leu) gene polymorphisms in patients diagnosed with major depressive disorder (MDD) and bipolar I disorder (BD). Eighty patients with MDD, 82 patients with BD (total 162 patients) and 96 healthy controls were enrolled in this study and genotyped using a Real Time-Quantitative Polymer Chain Reaction (RT-qPCR)-based method. The patients with BD and MDD and the controls had a similar distribution of the genotypes and alleles in the Ala-9Val MnSOD gene polymorphism. Comparison of the MDD group and control group regarding the Pro 197 Leu GSH-Px gene polymorphism revealed similar genotype distribution but different allele distribution. The BD group and control group were similar both for genotypes and for alleles when compared regarding the Pro 197 Leu GSH-Px gene polymorphism. The combined analysis (MDD plus BD) also failed to find any association between the Ala-9Val MnSOD and Pro 197 Leu GSH-Px gene polymorphism. Although small statistical power of the current study the significant difference between patients with depression and the control group for the Pro 197 Leu GSH-Px polymorphism indicates that the distribution of these alleles may have a contribution in the physiopathogenesis of depression. One of the limitation of the current study is that the sample size is too small. Understanding of the exact role of Pro 197 Leu GSH-Px polymorphism in the development of depression needs to further studies with more sample size and high statistical power.

The effect of agoraphobia on oxidative stress in panic disorder.

We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.

The changes in tear film parameters and impression cytology in heavily drinking men.

PURPOSE: To evaluate the tear film function and ocular surface changes in heavily drinking men. METHODS: This prospective case-control study involved 35 male subjects with heavy alcohol consumption (group 1) and 35 age- and sex-matched control subjects (group 2). Best-corrected visual acuity measurement, slit-lamp examination, Schirmer I test, tear film break-up time (BUT) measurement, and conjunctival impression cytology were performed in all subjects. The results were compared between the 2 groups. RESULTS: The mean Schirmer I test results in group 1 and group 2 were 8.31 ± 3.56 mm and 13.17 ± 5.71 mm, respectively, and the mean BUT values were 9.22 ± 3.10 seconds and 13.20 ± 4.04 seconds, respectively. The mean Schirmer I and BUT results were statistically lower in group 1 than in group 2 (P < 0.0001). The mean impression cytology scores in group 1 and group 2 were 2.08 ± 0.78 and 1.37 ± 0.94, respectively. A statistically significant difference was noted between the study and control groups for the grading of cytological changes (P = 0.001). CONCLUSIONS: Our data showed that heavily drinking men have decreased tear production, tear film instability, and significant degeneration of the ocular surface epithelium when compared with normal subjects.

Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common psychiatric illness. Although the aetiology of OCD is still unknown, the family-genetic data show that familial forms of OCD may be associated with a specific genetic susceptibility. Recent investigations have associated development of OCD with infectious illness. Toxoplasmic encephalitis (TE) is a common presentation of Toxoplasma gondii infection of the central nervous system (CNS). The most commonly affected CNS region in TE is the cerebral hemisphere, followed by the basal ganglia, cerebellum and brain stem. The basal ganglia has been implicated in the development of OCD. Therefore, in this study, it was aimed to investigate a possible association between Toxoplasma infection and OCD. We selected 42 patients with OCD and 100 healthy volunteers, and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). The sero-positivity rate for anti-T. gondii IgG antibodies among OCD patients (47.62%) was found to be significantly higher than the rate in healthy volunteers (19%). This is the first report to examine a potential association between Toxoplasma infection and OCD. The main finding of the present study is an increased level of IgG antibodies to T. gondii in OCD patients when compared with the level in healthy controls. There might be a causal relationship between chronic toxoplasmosis and the aetiology of OCD.

Total antioxidant capacity and total oxidant status in patients with major depression: impact of antidepressant treatment.

AIM: The purpose of the present study was to investigate whether total antioxidant capacity (TAC) and total oxidant status (TOS) are associated with major depressive disorder (MDD) and to evaluate the impact of antidepressant treatment on TAC and TOS in MDD. METHODS: Fifty-seven MDD patients and 40 healthy controls participated in the study. Serum TAC and TOS were measured both in patients and controls using Erel's methods. Patients were treated with antidepressant drugs for 12 weeks. The treatment course was evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) in all patients. RESULTS: TOS and oxidative stress index (OSI) were higher (P = 0.0001 for both) and TAC was lower (P = 0.0001) in the MDD group compared with those of the controls. After 3 months of antidepressant treatment, TOS and OSI were decreased and TAC was increased compared with the pretreatment values (P = 0.0001, for all). Furthermore, there were significant positive correlations between the severity of the disease and serum TOS and OSI (r = 0.584, P = 0.0001; r = 0.636, P = 0.0001, respectively). A negative correlation was found between the severity of the disease and serum TAC (r = -0.553, P = 0.0001) at the pre-treatment stage. CONCLUSION: Treatment administered for 3 months to MDD patients increases TAC while decreasing TOS and OSI.

[Development of a questionnaire to assess inter-episode functioning in bipolar disorder: Bipolar Disorder Functioning Questionnaire]. / Bipolar Bozuklukta Islevsellik Olçeginin Gelistirilmesi, Güvenilirlik ve Geçerliligi.

OBJECTIVE: Even though quality of life and functioning are topics that are point of interest, they are not assessed adequately in mood disorders. In this study, it is aimed to develop a functioning assessment scale in bipolar disorder. METHOD: Bipolar Disorder Functioning Questionnaire (BDFQ) is developed by the Scientific Section for Mood Disorders of the Psychiatric Association of Turkey. The questionnaire contains 58 items, and consists of eleven subscales: emotional functioning, intellectual functioning, sexual functioning, feelings of stigmatization, social withdrawal, household relations, relations with friends, participation to social activities, daily activities and hobbies, taking initiative and self sufficiency, and occupation. RESULTS: In this study, 252 remitted bipolar patients from 15 centers were included. In addition, thirty subjects without any lifetime psychiatric, neurological or physical disease were recruited. The mean age of the patients was 38.6+/-12.1 and 56% (n=141) were female. The mean duration of the bipolar disorder was 11.9+/-9.2 years, and 91.3% of the patients were diagnosed to have bipolar I disorder. In the reliability analyses, after the exclusion of six items with low reliability coefficients, The Cronbach alpha coefficient was calculated to be 0.91. The item-total scale correlations were between 0.22-0.86. In test-retest reliability, the correlation between the two ratings was high (r=0.82, p<0.0001). In validity analyses, 13 factors were obtained representing 65.1% of the total variance in exploratory factor analysis. In confirmatory factor analysis, 11 domains fit the model with a RMSEA of 0.061. BDFQ significantly correlated with GAF (r=0.428, p<.0001). BDFQ also showed significantly negative correlation with HAM-D (r=-0.541, p<0.0001) and YMRS (r=-0.365, p<0.0001). It discriminated the patients (mean score=111.8+/-15.2) from the healthy subjects (mean score=121.4+/-10.4) well (t=-2.300, p=0.038). CONCLUSION: With the six items excluded, it is suggested that the 52-item BDFQ is a reliable and valid instrument in the assessment of functioning in bipolar disorder.

The role of oxidative stress in postoperative delirium.

AIM: This study aimed to determine a marker that predicts delirium using preoperative oxidative processes in patients undergoing cardiopulmonary bypass surgery. METHOD: Twelve of the 50 patients included in the study showed signs of delirium during postoperative follow-up. The Delirium Rating Scale was used in patients with delirium according to DSM-IV-TR in the postoperative period. Venous blood samples were obtained from the patients the day before and the day after the surgery to determine plasma antioxidant enzyme levels. RESULTS: While there were no differences in preoperative superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) levels in both groups, catalase (CAT) levels were significantly lower in the delirium group. Postoperative SOD and MDA levels were also higher in the delirium group, while the GSH-Px levels were found to be lower when compared with those during the preoperative period. In the nondelirium group, the postoperative MDA and GSH-Px levels were found to be lower than preoperative levels, and postoperative SOD levels were found to be higher than preoperative levels. CAT levels were lower in the delirium group when the pre- and postoperative levels were compared in both groups. The postoperative levels of SOD, GSH-Px and CAT in the nondelirium group and MDA in the delirium group were significantly higher than preoperative levels. CONCLUSION: Patients with low preoperative CAT levels appeared to be more susceptible to delirium than patients with higher CAT levels.

Reduced P50 auditory sensory gating response in professional musicians.

Evoked potential studies have demonstrated that musicians have the ability to distinguish musical sounds preattentively and automatically at the temporal, spectral, and spatial levels in more detail. It is however not known whether there is a difference in the early processes of auditory data processing of musicians. The most emphasized and studied early process, especially for neuropsychiatric purposes, is sensory gating. The suppression percentage of the midlatency auditory evoked potential P50, and rarely the N100, wave is used for sensory gating studies. Our aim in this study was to investigate whether there was a difference in the auditory P50 and N100 suppression of control subjects who were professional musicians with no psychiatric problems. 34 professional musicians and 19 non-musicians (the control group) were included in this study. P50 and N100 measurements were taken, the suppression percentage of P50 and N100 was calculated and the results compared. Musicians showed significantly less P50 suppression when compared to non-musicians. There was no significant difference for N100 suppression. What the decreased P50 suppression in musicians when compared to non-musician subjects means, when we also take into account that N100 suppression is not decreased, and how it may contribute to the music perception and production processes of these persons is discussed.

Sympathetic skin response in premenstrual syndrome.

Premenstrual syndrome is a term which includes a broad group of emotional, behavioral and physical symptoms that occur for several days before menses and subside following the menstrual period. Many women experience premenstrual syndrome symptoms, particularly physical ones such as breast tenderness and swelling. Approximately 5-10% women suffer from severe premenstrual syndrome and another 30-40% have moderate symptoms. Premenstrual syndrome continues to be an unsolved problem. In this study, we evaluated 24 premenstrual syndrome patients and 20 healthy women in the control group. The ages of the women were 22-34 years (mean +/- SD: 25+/-3) for the premenstrual syndrome group and 23-34 (25+/-3) for the control group. The sympathetic skin response was recorded from the palms, soles and genital regions by using electrical stimuli to the median nerve at the wrist. The sympathetic skin response was recorded twice, in the follicular and late luteal phases of menstruation. The follicular and late luteal phase sympathetic skin response of the two groups were compared. The amplitudes and latency values of the late luteal and follicular phase sympathetic skin response from the premenstrual syndrome group and control group women were statistically similar. We also did not find any latency or amplitude difference in the sympathetic skin response obtained from the three regions of the premenstrual syndrome patients and the control group. We checked sympathetic skin response in the symptomatic (late luteal phase) and asymptomatic (follicular phase) periods of patients with premenstrual syndrome, a disorder known to have many autonomic symptoms, to determine whether there was sudomotor sympathetic involvement. The results of our PMS patients indicate at the very least that there is no difference with the control subjects as regards peripheral sudomotor functions.

Cognitive event-related potential and neuropsychological findings in Behcet's disease without neurological manifestations.

Behcet's disease (BD) is a multisystem inflammatory disorder characterized by recurrent oral and genital ulcers and uveitis. BD patients without neurological involvement frequently have mild neurological symptoms. The aim of this study was to evaluate whether BD patients without neurological involvement have any changes in cognitive functions. Twenty BD patients without neurological involvement and 13 control subjects were included in the study and were analyzed by neurophysiological and neuropsychological examinations. The cognitive event-related potentials (P300) were recorded from the frontal, central and parietal areas of the right and left hemispheres of the patients and control subjects. Likewise, all individuals were evaluated with neuropsychological tests. In contrast to a study with similar design, we did not find any difference between the cognitive event-related potentials values of BD patients without neurological involvement and the control subjects. All BD patients without neurological involvement exhibit normal results of the neuropsychological test. In conclusion, the results of neuropsychological tests and cognitive event-related potentials values in BD patients without neurological involvement are indistinguishable from those in control subjects and no alteration of cognitive functions is present.

Topographic abnormalities in event-related potentials in children with monosymptomatic nocturnal enuresis.

AIMS: A functional maturational delay in the central nervous system is dwelled upon in the pathogenesis of monosymptomatic nocturnal enuresis (MNE). In this study we studied whether according to controls N200 and P300, components of the event-related potential (ERP), which is related to aspects of cognitive processing, showed any difference in its topographic distribution in children within the age group 10-13 with monosymptomatic nocturnal enuresis and discussed its relation to the pathogenesis of MNE. METHODS: We performed P300 in 18 patients with MNE and in 16 age-matched healthy subjects. P300 were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. RESULTS: There was no statistical difference between the enuretic group and the controls in N200 and P300 latency and amplitude in the midline frontal (Fz), central (Cz), and parietal (Pz) recording site of the 10-20 International System. In the enuretic group while P300 amplitude in the Fz site was significantly less than the P300 amplitude in the Cz site, there was no statistical difference between the Fz and Pz P300 amplitude values. CONCLUSIONS: When different levels of maturational delay are considered in MNE, it may be claimed that maturational delay in children whose enuresis lasts until older ages will be different from those whose enuresis ends at an early age. The determination of P300 amplitude in parietal records being less in enuretics when compared to the controls may show that there are regional differences in stimuli processing rate/quality.