Double Blind Controlled Study of Adding Folic Acid to Fluoxetine in the Treatment of OCD.

BACKGROUND: Folate is important for the synthesis of serotonin the neurotransmitter which plays a main role in OCD. We, therefore, explored the efficacy of folic acid as add on treatment to fluoxetine in a double blind study among patients with OCD. SUBJECTS AND METHODS: A double blind, 12-week study comparing the efficacy of folic acid as add on treatment and placebo in patients with OCD was conducted on thirty six (36) patients. Patients were randomly assigned to folic acid (5 mg/day) or placebo group in addition to fluoxetine (40 mg/day). After the baseline assessment, on week 2, 4, 6, 8 and 12 assessments were performed by using YBOCS, HAM-D, HAM-A and CGI-S. Serum folate, erythrocyte folate, serum homocysteine and B12 levels were measured both baseline and the end of study. RESULTS: A mixed model repeated measures ANCOVA on Y-BOCS scores were used to determine the difference between folic acid and placebo groups. No significant differences were found in the ratios of gender or in the mean age, serum folic acid level, erythrocyte folate level, serum homocysteine level and serum B12 level between the treatment groups at the baseline. Consecutively scores collected over six measurements on YBOCS, HAM-D, HAM-A and CGI showed non-significant differences between folic acid and placebo groups. CONCLUSION: None of the biological markers of one carbon metabolism were associated with the change in YBOCS scores. It may be assumed that there is no beneficial effect of folic acid addition to fluoxetine in the treatment of OCD.

Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy.

BACKGROUND: This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns. METHODS: Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about their drug use patterns was obtained from their relatives/caregivers/nurse. The Clinical Global Impression Scale (severity of illness) and the General Assessment of Functionality scales were also administered. RESULTS: Patients with schizophrenia used 2.0 ± 0.81 antipsychotics daily and 3.52 ± 2.55 pills (1-18). Seventy-one percent of the patients used two or more kinds of psychotropic drugs. The most frequently used antipsychotics were quetiapine, a second generation antipsychotic, and haloperidol, a typical antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy. CONCLUSION: The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.

Burden on Caregivers of Patients with Schizophrenia and Related Factors.

INTRODUCTION: Caregivers of patients with schizophrenia are under the burden of continuous and difficult processes. Determination of the factors related to caregiver burden in schizophrenia may help find strategies to decrease the burden. This study aimed at investigating the factors associated with caregiver burden among relatives of patients with schizophrenia. METHODS: Eighty-eight caregivers of patients under treatment for schizophrenia for at least 1 year were included in the study. The Zarit Caregiver Burden Interview was used for the assessment of caregiver burden. Sociodemographical data, the level of knowledge about schizophrenia, clinical impression scale, and global assessment of functioning were used to evaluate the related factors. RESULTS: Caregiver burden was negatively correlated with income level and functionality of the patient and was positively correlated with the age of the caregiver, the daily time spent with the patient, and the number of hospitalizations of the patient (p<0.05). There was no significant correlation between the caregivers' knowledge about schizophrenia and caregiver burden (p<0.05). Living in the same house with the patient was a positive predictor, whereas functionality and income level of the patient and education level of the caregiver were negative predictors (p<0.05). CONCLUSION: This study highlighted the importance of setting targets for improving the functionality of patients in the design and implementation of rehabilitation and support programs for patients with schizophrenia. Additionally, providing higher income for patients, creating conditions for an independent life, and increasing incentives for younger caregivers with a higher educational level may help decrease caregiver burden.

Affective temperaments in pregnancy.

AIM: There are many studies on the mood disorders that occur during pregnancy, but no studies that question how affective temperaments, which are the antecedents of the mood disorders, are influenced by pregnancy. This study aims to examine the affective temperaments in women without any psychiatric diagnoses during the pregnancy period. METHOD: The study included 100 pregnant women at the third trimester of their pregnancy (pregnant group) and 75 non-pregnant women (control group). Structured Clinical Interview for DSM Axis-I Disorders (SCID-I) was used for the evaluation of psychiatric disorders; Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A) was used for the evaluation of affective temperaments. RESULTS: The cyclothymic, irritable and anxious temperament scores of the pregnant women were significantly lower than that of the non-pregnant women (p < 0.05). Pregnancy predicted lower scores of cyclothymic, irritable and anxious temperaments. Younger age and lower levels of education were predictors of higher cyclothymic, anxious and depressive temperament scores. Younger age also predicted higher irritable temperament scores. CONCLUSION: The third trimester of pregnancy is associated with significantly lower affective temperament. Future studies may help to understand the biological background of the present findings.

Comparing ECT data of two different inpatient clinics: propofol or thiopental?

OBJECTIVE: This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II). METHODS: Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study. RESULTS: A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others. CONCLUSIONS: The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.

Post-traumatic stress disorder among asylum seekers and refugees in Istanbul may be predicted by torture and loss due to violence.

BACKGROUND: Turkey is both a source and target for asylum seekers seeking refugee status in countries of European Union. There is a scarcity of research on the mental health issues of asylum seekers and refugees residing in Turkey. AIMS: This study aimed: 1) to provide clinical and demographic information on asylum seekers and refugees receiving mental health services from a non-governmental refugee support program in Istanbul between 2005 and 2007, and 2) to evaluate the differences between patients diagnosed with post-traumatic stress disorder (PTSD) with those who did not meet criteria. METHODS: The study was conducted at the Mental Health Division of the Refugee Advocacy Support Group. Between July 2005 and February 2007, 1209 asylum seekers applied to the support group; 75 of these individuals (6.2%) were referred for psychiatric evaluation while 57 were diagnosed as having a psychopathology. The number of analyzed subjects was 57. RESULTS: PTSD and major depressive disorder were the most common diagnoses (55.2% for both). The most common criteria of PTSD reported were problems in concentration and social isolation (97.3% for both). Suffering torture and losing a significant other due to violence were found to be associated with a diagnosis of PTSD. CONCLUSIONS: This study is the first of its kind to be conducted on a mixed refugee population residing in Turkey and focusing on their mental health problems. Our results should be tested within larger samples of refugees residing in different cities of Turkey.

The evaluation of suicide letters in Turkey from a cognitive perspective.

BACKGROUND: Different methods are used to understand the suicidal mind. Suicide note analysis may be most direct way to do this. AIMS: To study the content of suicide letters under forensic evaluation in terms of psychological and cognitive aspects. METHODS: A total of 51 letters were referred to The Council of Forensic Medicine from different cities of Turkey and analyzed by a research group with ten members including forensic medicine specialists and psychiatrists. The Questionnaire of Content Analysis of Suicide Letters (The Q-CAS), developed by researchers, was used to analyze the cognitive and cultural themes of suicide letters. The cognitive distortions about the self, the world, and the future as well as cultural phenomena were evaluated including sociodemographic features. RESULTS: Financial problems in males and relationship problems in females were the most frequent life events related to suicide. Hopelessness, weakness, loneliness--in decreasing order--were the most predominant cognitions and emotions. The total score of females were higher than that of males (p=.002). CONCLUSIONS: These negative cognitions should be taken into consideration when therapeutic interventions are planned on individuals with suicidal thoughts.

Assessment of lifetime history of exposure to traumatic stressors by incarcerated adults with the Turkish version of the Traumatic Events Screening Instrument for Adults (TESI-A): a pilot study.

OBJECTIVE: To determine the prevalence of Criterion A traumatic events and current posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in prisoners in Kocaeli Closed Prison. METHOD: The study was conducted in Kocaeli Closed Prison in Turkey. The sample consisted of 30 female and 30 male prisoners who had been in prison for at least 1 month. The PTSD and MDD section of the Structured Clinical Interview for DSM-IV and the Traumatic Events Screening Instrument for Adults were used by experienced clinicians. RESULTS: Most (n = 52, 86.7%) participants reported lifetime exposure to at least 1 Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD Criterion A event. Although the August 17, 1999, earthquake was the most prevalent traumatic event (n = 31, 51.7%), it was not related to the risk of current PTSD in prisoners. Current PTSD was rare among men (n = 2, 6.7%) and women (n = 3, 10%) but more prevalent than in community surveys of adults. Traumatic events that were relatively unique to the incarcerated population (e.g., committing murder) were identified. Moreover, 17% of women (n = 5) and men (n = 5) were diagnosed with MDD. Traumatic events that had the strongest conditional probabilities of association with a diagnosis of PTSD and MDD were identified. CONCLUSION: Exposure to traumatic stressors was highly prevalent among prisoners. Ongoing interpersonal traumatic events were particularly likely to be experienced as traumatic and related to PTSD and MDD, and violent criminal acts may be highly traumatic for the perpetrator.