Neuropsychiatric Effects of Bilateral Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: Results at the 12-Month Follow-up.

Introduction: It is aimed to report the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on motor symptoms, neuropsychiatric symptoms, and quality of life in Parkinson's Disease (PD) patients. Methods: The results of 22 patients with PD, who had undergone bilateral STN-DBS, were analyzed. The Unified Parkinson's Disease Rating Scale (UPDRS) was applied to assess the patients' clinical characteristics before surgery and 6-, and 12-month follow-up after surgery. The quality of life of the patients was evaluated with the Parkinson's Disease Questionnaire (PDQ-39). Neuropsychological tests including Minnesota Impulse Control Disorders Interview (MIDI), Beck Depression Inventory-II (BDI), Hospital Anxiety and Depression Scale (HADS), Lille Apathy Rating Scale (LARS), and Mini-Mental State Examination (MMSE) were also routinely performed at baseline and 6 months and 12 months after surgery. Results: The mean age of patients was 57.3±8.8 years. Fourteen patients (63.6%) were male. Significant improvements were seen in UPDRS-part-II, UPDRS-part-III UPDRS-part-IV, and PDQ-39 in the follow-ups after the surgery. No significant change was observed in 6- and 12-month follow-up visits for BDI, HADS, MMSE, and LARS, compared to baseline. A depressive episode, requiring antidepressant treatment was recorded in four (18.1%) patients. Before DBS surgery, eight patients had at least one current impulse control behaviors (ICBs). Among these eight patients; ICBs disappeared in one patient, did not change in two patients, and worsened in five patients after STN-DBS treatment. Conclusion: In patients with a history of psychiatric disease, bilateral STN-DBS treatment may aggravate psychiatric symptoms such as depression, and ICBs.

Evaluation of Executive Functions With Functional Near-Infrared Spectroscopy in Euthymic Bipolar and Borderline Personality Disorders.

Introduction: Bipolar disorder (BD) and borderline personality disorder (BPD) are often indistinguishable, given both the key features of impulsivity and emotional dysregulation. This indicates widespread comorbidity and potential misdiagnosis in both groups. Therefore, this study aimed to differentiate BD and BPD by using alterations of brain hemodynamics under the influence of executive tests. Methods: Twenty patients with the euthymic phase of BD and 20 patients with BPD, and 20 healthy control subjects were included in this study. The prefrontal cortex (PFC) hemodynamic responses were evaluated using functional near-infrared spectroscopy (fNIRS) during the Stroop Test and Wisconsin Card Sorting Test (WCST). Results: Left dorsolateral prefrontal cortex (DLPFC) activation was significantly decreased in BPD during both tests. On the other hand, the BD group showed medial PFC hypoactivation during both tests, and this finding is distinct from BPD (p<0.05). Conclusion: Our results indicate that brain hemodynamics during the executive test can highlight differences between BP and BPD. While medial PFC hypoactivation was more prominent in the BP group, DLPFC hypoactivation was more pronounced in the BPD group.

Depression and Psychological Distress in Medical Students, A Prospective Study.

Introduction: The aim of the study is to determine the changes in psychological distress and depressive symptoms of medical students in the first two years of their education process, in comparison with other faculty students. Methods: All first-year students in the Faculties of Medicine, Economics and Sport Sciences were asked to fill out a detailed self-reported questionnaire aimed at measuring possible stressful life events and habits, General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI) during the first week of their first semester in 2017-2018. This process was repeated to the same students again in the second year, and the change was examined prospectively. Results: The GHQ-12 score average increased from 11.19 to 13.7 in medical students (p<0.001). The prevalence of psychological distress increased from 53.8% to 61.8%. The BDI score average was 8.04 in the beginning and reached 10.1 in the second year (p<0.001). Depressive symptom prevalence increased from 8.8% to 19.5%. No significant increase was observed in the GHQ-12, BDI score average, depressive symptoms, and psychological distress prevalence of other faculty students. The incidence of depressive symptoms in medical students was 15.9%. As a result of multivariate analysis, "dissatisfaction with social activities" and "exposure to psychological pressure and violence" which were stressful life events were statistically associated with both GHQ-12 and BDI. Conclusion: It was determined that the mental health of the students was negatively affected in the first year of medical school education. It is recommended to raise awareness for medical students at risk of mental illness and to plan interventions that will protect their mental health.

Levels of TNF alpha, Soluble TNF Receptors (sTNF-R1, sTNF-R2) in Bipolar Disorder.

INTRODUCTION: Current evidence suggests that pro-inflammatory cytokines, particularly tumor necrosis factor alpha (TNF-α) may play an important role in the pathophysiology of bipolar disorder (BD). Our study aims to compare BD patients and controls in terms of serum TNF-α, soluble tumor necrosis factor receptor 1 and soluble tumor necrosis factor receptor 2 (sTNF-R1, sTNF-R2) levels in different phases of BD. METHODS: Eighty-three patients with BD type 1 (27 manic, 22 depressive and 34 euthymic) and twenty-nine healthy controls were included in the study. Serum levels of TNF-α, sTNF-R1, sTNF-R2 levels were evaluated with ELISA kit. RESULTS: Levels of sTNF-R1 were showed a statistically significant difference between groups. Levels of sTNF-R1 were higher in depression or mania patients than euthymia patients and control subjects. A statistically significant difference in the serum level of sTNF-R1 between patients in acute episode (mania and depression) group and stabile (patients in euthymic episode and controls) group was found in logistic regression analysis. The probability of having acute episode increased threefold for each unit increase in serum level of sTNF-R1. There was no statistically significant difference between the mean serum values of TNF-α and sTNF-R2 between the groups. CONCLUSIONS: sTNF-R1 production was different between acute episode patients and controls or stable BD patients. The result of this study confirms that TNF-R1 may be a state marker representing disease activity for BD.

Epilepsy and stigmatization in Turkey.

Patients with epilepsy experience stigmatization quite often. Studies investigating stigmatization perceived by patients with epilepsy in Turkey are limited in number. In this study, we aimed to understand the relationship between stigmatization and psychopathology and also to identify the effects of stigmatization on the quality of life in epilepsy. Patients completed a socio-demographical data form and epilepsy information form. They were evaluated in terms of psychiatric diagnosis using SCID I and they were asked to complete SCL-90 R, Epilepsy Stigmatization Scale and SF 36. The percentages of patients who did and did not report perception of stigmatization were similar in the study group. Depression was the most common diagnosis followed by anxiety disorder. In comparison to patients who did not feel stigmatized, patients who reported perceived stigmatization had a higher frequency of generalized tonic clonic seizures and injuries during seizures and more frequently missed taking their medication. They also showed higher rates of both suicide attempts and psychopathology as evidenced by a higher rate of psychiatric diagnosis and higher score in all the subscales of SCL 90. With regard to their quality of life they were observed to be more disabled in the physical functioning, general health perception, vitality, social role functioning and mental health dimensions. A logistic regression analysis revealed that stigmatization was best predicted by three variables: history of suicide attempts, receiving a psychiatric diagnosis and higher score in SCL90PST. Our study has shown that psychopathology is a more significant predictor of stigmatization than the other variables related with seizure control.

Internalized stigma in psoriasis: A multicenter study.

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Levels of TNF-α, soluble TNF receptors (sTNFR1, sTNFR2), and cognition in bipolar disorder.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-α) may play an important role in bipolar disorder (BD) pathogenesis. There is only one study about a relationship between TNF-α levels and cognitive impairments in BD. The aim of the present study was to see whether TNF-α, soluble P55 TNF receptor (sTNFR1), and soluble P75 TNF receptor (sTNFR2) levels in BD patients are different from controls and to investigate the relationships between the levels of TNF-α, sTNFR1, and sTNFR2 and the cognitive functions in euthymic BD patients and controls. METHODS: We assessed 54 BD type I patients and 18 controls by using a battery of neuropsychological tests. Serum TNF-α levels were measured using a commercially available enzyme-linked immunosorbent assay, whereas serum sTNFR1 and sTNFR2 levels were measured using a commercially enzyme-amplified sensitivity immunoassay kit. RESULTS: We found that levels of sTNFR1 and sTNFR2 in BD patients were different from controls. No difference was detected between the BD group and the control group for levels of TNF-α. TNF-α level was found to have a negative correlation with the delayed recall in RAVLT. CONCLUSIONS: High levels of sTNFR1 and sTNFR2 in euthymic patients showed that it may support that proinflammatory process continues in euthymic period. This is the first study which showed increased sTNFR2 levels in euthymic period, which could be interpreted as a compensatory mechanism and again the first which deals with verbal memory.