Diagnostic Transitions from Primary Psychiatric Disorders to Underlying Medical Conditions: A 5-Year Retrospective Survey from a University Hospital Sample.

Background: Undiagnosed underlying medical conditions can cause many patients to be followed, for years, by a diagnosis of a primary psychiatric disorder and to receive inappropriate treatment. The aim of this study was to determine the prevalence of patients initially diagnosed with a primary psychiatric disorder but whose symptoms were later attributed to medical conditions. These patients' initial and final diagnoses were also examined. Methods: The records of 1843 patients hospitalized in Gazi University Faculty of Medicine Psychiatric Inpatient Clinic between 2015 and 2020 were examined in this retrospective and descriptive study. Thirteen patients were excluded from the study due to insufficient data. Descriptive statistics were performed on the data of 30 patients diagnosed with an underlying medical condition. Results: In follow-up, 49 patients' diagnoses changed. 19 patients had a diagnosis unrelated to an underlying medical condition, and 30 had a diagnosis related to an underlying medical condition. Five (16.7%) of the patients, previously known to have psychiatric disorders, were found to have Alzheimer's disease. Brain space-occupying lesions, frontotemporal dementia, epilepsy, Parkinson's disease, and Arnold-Chiari malformation followed Alzheimer's disease at 6.7% (n = 2). The mean time until the diagnosis of the patients was revised was 4.95 years (standard deviation [SD] = 7.78). It was observed that psychotropic medications (90%) were used more than non-psychotropic drugs until the diagnosis was revised. Conclusion: During the diagnostic process, we believe that clinicians should be aware of potential underlying medical conditions and that the multidisciplinary work of psychiatry and neurology is also crucial.

Turkish Adaptation, Validity, and Reliability Study of Shitsu-Taikan-Sho (Alexisomia) Scale.

Background: The Shitsu-Taikan-Sho (Alexisomia) Scale is a self-report scale for measuring alexisomia, defined as the difficulty in awareness and expression of somatic emotions or feelings. The scale is available in Japanese and Finnish versions. This research aims to examine the psychometric properties of the Turkish version of the Shitsu-Taikan-Sho (Alexisomia) Scale. Methods: The study sample consists of 320 patients who applied to the outpatient clinic of consultation-liaison psychiatry. Participants completed the Sociodemographic Information Form, the Turkish version of the Shitsu-Taikan-Sho (Alexisomia) Scale, and the Toronto Alexithymia Scale. Internal consistency and test-retest reliability were used for reliability analyses. Exploratory factor analysis, confirmatory factor analysis, and co-validity analyses were used for validity analyses. Results: According to the exploratory factor analysis results, a 3-factor, 18-item model for the Turkish version of the Shitsu-Taikan-Sho (Alexisomia) Scale explained 48.3% of the variance (Kaiser-Meyer-Olkin = 0.866; χ 2 = 1535.3, P < .001). Confirmatory factor analysis results indicated a good fit (χ 2 = 234.893; SD = 132; χ 2/SD = 1.779; CFI = 0.927; GFI = 0.923; RMSEA = 0.049). In the co-validity analysis, a significant correlation was found between Toronto Alexithymia Scale-20 and Turkish version of the Shitsu-Taikan-Sho (Alexisomia) Scale (r = 0.556, P < .001). Cronbach's alpha coefficient was 0.825 for the total score, 0.711 for lack of health management based on bodily emotions, 0.794 for difficulty in describing bodily emotions, and 0.775 for over adaptation. The interclass correlation coefficient between the 2 measures of Turkish version of the Shitsu-Taikan-Sho (Alexisomia) Scale was 0.883 (P < .001). Conclusion: The Turkish adaptation of the Shitsu-Taikan-Sho (Alexisomia) Scale demonstrated adequate psychometric properties. It is an appropriate scale for evaluating the concept of alexisomia in the population of consultation-liaison psychiatry.

The Effect of the New Type Coronavirus Outbreak on Quality of Life and Suicidal Thoughts in Psychiatric Patients. / Yeni Tip Koronavirüs Salgininin Psikiyatrik Hastalarda Yasam Kalitesi ve Intihar Düsüncelerine Etkisi.

OBJECTIVE: The aim of this study is to investigate the effect of perceptions on the COVID-19 pandemic on the quality of life and suicidal ideation in both healthy controls and individuals with psychiatric disorders. METHOD: The study was conducted on 4 different groups with 83 depressive disorders, 90 anxiety disorders and 61 schizophrenia patients who have been followed in Gazi University Medical Faculty Hospital Mental Health and Diseases outpatient clinic since before the COVID-19 pandemic period and another group of 93 healthy volunteers. Participants were evaluated with Sociodemographic Data Form, Suicide Probability Scale (SPS), SF-36 Quality of Life Scale (SF- 36), Perception of COVID-19 Scale (P-COVID-19), and Perception of Causes of COVID-19 Scale (PCa-COVID-19). RESULTS: The perception on the danger and contaigiousness of P-COVID-19 scored lowest in the schizophrenia group, compared to other groups and PCa-COVID-19's Conspiracy and Belief subdimension scores were highest. In all groups, a significant negative correlation was found between the P-COVID-19's dangerousness subdimension score and the SF-36 scale's Mental Health sub-dimension. Again, in all groups, significant positive correlations were found between the Dangerousness sub-dimension score of P-COVID-19 and the anger/impulsivity, hopelessness/loneliness and suicidal thoughts sub-dimensions of the SPS. CONCLUSION: The negative effects of perceptions associated with COVID-19 on mental health were observed both in groups with a psychiatric disorder and in healthy controls. The higher number of participants and longitudinal research will provide a better understanding of the effects of perceptions associated with COVID-19 and will guide the necessary treatment interventions.

Dietary patterns and eating behaviors on the border between healthy and pathological orthorexia.

PURPOSE: The obsession with healthy eating associated with restrictive behaviors is called Orthorexia Nervosa (OrNe). Nevertheless, some studies suggest that orthorexia can also be a non-pathological interest in healthy eating which is called Healthy Orthorexia (HeOr). First, one of the main objectives of this study is to compare HeOr, OrNe and eating behaviors in different dietary patterns (vegan, vegetarian and omnivore). Second is to reveal the relationship between HeOr, OrNe and eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating). Lastly, to determine the potential predictors of HeOr and OrNe. METHODS: Participants (N = 426 with an omnivorous diet; N = 415 with a vegan diet, N = 324 with a vegetarian diet) completed a web-based descriptive survey, the Teruel Orthorexia Scale and the Three-Factor Eating Questionnaire-R 21. RESULTS: HeOr and OrNe were more common in individuals following both vegan and vegetarian diets. Individuals following a vegan or a vegetarian diet had lower body mass index and higher body image satisfaction than individuals following an omnivorous diet. Cognitive restraint and following a vegan or a vegetarian diet were the two main predictors of both HeOr and OrNe. Cognitive restraint was positively associated with both HeOr and OrNe (more strongly correlated with OrNe), whereas uncontrolled eating and emotional eating behaviors were positively related to OrNe and negatively related to HeOr. CONCLUSION: The present study contributes to a better understanding of the some similarities and differences between HeOr and OrNe. It also points to higher rates of orthorexia in individuals following a vegan or vegetarian diet and represents a further step towards developing prevention and intervention programs by identifying risk factors for OrNe. Level V Cross-sectional descriptive study.

Effect of Structured Cognitive-Behavioral Group Therapy on Body Weight, Mental Status and the Quality of Life in Obese and Overweight Individuals: A 16-Week Follow Up Study. / Obez ve Asiri Kilolu Bireylerde Yapilandirilmis Bilissel Davranisçi Grup Terapisinin Vücut Agirligi, Ruhsal Durum ve Yasam Kalitesi Üzerine Etkisi: 16 Haftalik Bir Takip Çalismasi.

OBJECTIVE: It was aimed in this study to investigate the effects of group cognitive and behavioral therapy (CBT) on the body weight, depression, anxiety, quality of life, self-esteem, dietary cognitive distortions and eating behavior of obese and overweight people. METHOD: The study was carried out at the Department of Psychiatry, Gazi University Faculty of Medicine, between 01.07.2017 and 31.12.2017. The participants attended group CBT sessions once weekly for eight weeks. Reinforcement sessions took place at the 12th and 16th weeks. At the first, 8th, 12th and the 16th weeks, body weights were measured and the participants were asked to complete the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), the Obese Individuals Specific Quality of Life Scale (OISQLS), the Dutch Eating Behavior Questionnaire (DEBQ), the Rosenberg Self-Esteem Scale (RSES) and the Diet Related Dysfunctional Attitudes Scale (DRDAS). RESULTS: The group mean age was 41.71±4.46 years, 32 (91.4%) being female. Significant improvements were found in body weight and the scores on the BDI, BAI, DEBQ, OISQLS, DRDAS, and the RSES (p<0.001 for each). The average percent weight loss was 10.2%. The BDI score was the best predictor of the change in body mass index (BMI). CONCLUSION: CBT-based group treatments for obese and overweight people are effective in losing weight. Therapy participants with less depression symptoms benefit more from treatment and lose more weight. These results should be re-evaluated in randomized controlled trials.

Readmission Rates and Causes Within The First Six Months After Discharge in Patients with Alcohol Addiction.

INTRODUCTION: Readmission rate is an important criterion that evaluates the quality of treatment and care. In this study, it was aimed to determine the rates of readmission and variables predicting readmission in patients with alcohol addiction. METHODS: The study sample consisted of 264 alcohol addiction patients with recurrent admissions between 2005-2017 at the Gazi University Hospital Alcohol and Drug Addiction Clinic. In the study, ICD-10 diagnostic classification was used. The differences between the medical comorbidity and psychiatric comorbidity of the patients during the first and second admissions were analyzed. RESULTS: The average age of the study sample was 51.45±12.04 and 89% (n=235) were male. In the second admission, the comorbid headaches (p=0.001), psychotic symptoms (p=0.013), anxiety disorder (p=0.003) and substance addiction (p=0.027) were significantly higher, and the length of hospital stay was shorter. In the first six months, 24.2% (n=64) of the sample was hospitalized again. While the comorbidity of anxiety disorder increased the risk of readmission within six months 2.2-fold (OR=2.240; p=0.031), the short duration of hospitalization (less than 35 days) increased the risk of readmission 2-fold (OR=0.492; p=0.026). DISCUSSION: Patients with a short hospital stay have an increased risk of readmission within the first 6 months after discharge. Policies that reduce the length of hospital stay in health services should be reviewed. However, it is noteworthy that in the second admission of patients with alcohol dependence, the diagnosis of drug addiction is added. To prevent this, issues related to substance abuse prevention should be addressed during the treatment stages of alcohol dependence.

Social Media Addiction in Young Adult Patients with Anxiety Disorders and Depression.

Objective: Although the relationship between social media addiction (SMA) and mental health is bidirectional, there have been very few attempts to investigate patients with depression or anxiety disorders in terms of SMA. The first aim of this study is to determine whether young adult patients diagnosed with depression or anxiety disorders have a tendency to become addicted to social media. The second aim of the study is to examine the effects of 6 DSM-based personality traits (dependent, histrionic, narcissistic, obsessive-compulsive, borderline, and paranoid) that commonly coexist with these disorders on SMA. Methods: This study was carried out with 276 participants between the ages of 18 and 35 in the Psychiatry Outpatient Clinic in Gazi University Hospital, Turkey. Seventy-three patients diagnosed with depression, 80 patients diagnosed with anxiety disorders, and 123 healthy controls were recruited for the study. The SMA Scale, Hospital Anxiety and Depression Scale, and the Personality Belief Questionnaire-Short Form were administered to the participants. Results: Patients with anxiety disorders (PAD) and patients with depression (PD) were more addicted to social media than healthy controls (HC) despite similar frequencies of social media use. Dependent, histrionic, narcissistic, obsessive-compulsive, borderline, and paranoid personality features in HC increased the susceptibility to SMA. Borderline and dependent personality features comorbid with PAD increased the susceptibility to SMA. None of the personality traits comorbid with PD had an effect on SMA. Conclusion: The present study will serve as a base for future studies which explore factors that can make PAD or PD more vulnerable to SMA.

Lujan-Fryns Syndrome Phenotype with Autism-Like Behavior and Atypical Psychotic Symptoms: Case Report. / Otizm Benzeri Davranis ve Atipik Psikotik Belirtileri Olan Lujan-Fryns Sendromu Fenotipi: Olgu Sunumu.

Lujan-Fryns Syndrome (LFS) is defined as a set of symptoms including mild-moderate mental retardation, marfanoid appearance, hypotonia at birth, hypernasal speech, characteristic craniofacial appearance and normal testis size. The frequency of the syndrome is not known thus the information obtained is solely based on case reports. Hereby, we present a patient with LFS diagnosis. The 29-year old male patient had mental retardation, aggression, and persecutory delusions, characteristic craniofacial and marfanoid features. During his speech pronominal reversal was observed ('the hurt him, he is so upset' when talking abour himself). After examination and genetic analysis, fragile X, Klinefelter, Marfan and Down syndromes and homocystinuria were eliminated as causes of mental retardation. A preliminary diagnoses of LFS done. No mutation was detected in exon 22 of the MED12 gene; but. Whole Exome Sequencing (WES) is ongoing. The patient was started on risperidone (4 mg/day) for psychotic symptoms and carbamazepine (200 mg/day) for impulse control and as an antiepileptic. After a follow up of 8 months, impulse control, psychotic symptoms and aggression improved significantly. Since the specific gene mutation of LFS was not determined in our case, we solely had to depend on clinical evaluation and genetic analysis. Although it is not easy to fully define or classify these syndromes, we believe every reported case will be a step in overcoming these difficulties.

A Case of Arachnoid Cyst Presenting with Cognitive Impairment and Hypomania Symptoms. / Bilissel Bozukluk ve Hipomani Belirtileriyle Basvuran Bir Araknoid Kist Olgusu.

Arachnoid cysts are benign congenital malformations of the arachnoid which account for approximately 1.4% of the intracranial lesions. Although it is usually asymptomatic, it may be accompanied by headache, hydrocephalus and seizure. Psychiatric disorders associated with arachnoid cysts are rare. In this article, we present a giant arachnoid cyst with hypomania symptoms and marked cognitive impairment. A 44-year-old female patient was admitted to our outpatient clinic with a 4-year history of headache, nervousness and attention problems. Magnetic resonance imaging revealed a giant arachnoid cyst with a size of 5.5x10.5x12.5 cm was found in the left hemisphere of the patient. Considering the patient's irritability, increase in the amount of speech, flight of ideas, sleep disturbance and attention disorders, the diagnosis of hypomania was made. The neuropsychological tests showed that the speed of information processing, mental flexibility and attention functions decreased, and executive functions were impaired. The patient was consulted to the neurosurgery department. But no surgical treatment was offered. Drug therapy for hypomanic symptoms and cognitive impairment was planned, but could not be started since the patient did not attend to the follow-up exams. Albeit the lack of followup constitutes a limitation for our report, we believe that the size of the cyst, significant impairment of cognitive functions and the presence of hypomania symptoms might contribute significantly to the literature. Other cases with arachnoid cyst displaying cognitive impairment were summarized in our article.

[Mania Associated with the Use of Bortezomib and Dexamethasone]. / Bortezomib ve Deksametazon Kullanimina Bagli Gelisen Mani Olgusu.

Bortezomib, an antineoplastic agent used in Multiple Myeloma, is a modified dipeptidyl boronic acid that is selectively and reversibly attached to the 26S proteasome. Bortezomib may be combined with corticosteroids in treatment-resistant multiple myeloma patients. Corticosteroids can cause many psychiatric disorders ncluding mania, depression, psychosis, delirium, suicide and aggression. To date only one case of mania associated with the use of bortezomib was reported in which the patient responded to the treatment with olanzapine and valproic acid. In this article, we present a 57-year-old female with multiple myeloma in whom mania developed after the use of bortezomib combined with dexamethasone.Psychiatric symptoms such as sleep deprivation, increased self-esteem and excessive speech appeared within the first week of bortezomib and dexamethasone treatment. Quetiapine was administered for the treatment of psychiatric symptoms. A gradual improvement was noted in manic symptoms after treatment. Bortezomib is a relatively new drug and there are only a few reports with respect to its psychiatric side effects. While using antineoplastic drugs such as bortezomib, caution should be exercised with regards to the psychiatric symptoms.

Psychiatric disorders comorbid with epilepsy in a prison sample.

PURPOSE: Epilepsy is an extremely widespread and serious neurological disease. Although comorbidities of psychiatric disorders are prevalent in epilepsy patients, quite often this coexistence could be overlooked. Studies in this area demonstrated that depression, anxiety disorders and schizophrenia are the most common psychiatric disorders accompanying epilepsy. Mental health problems are known to be more common in prisoners compared to general population. The present study aims to demonstrate the psychiatric comorbidities in prisoners diagnosed with epilepsy. METHOD: In this study, demographic data and the psychiatric comorbidity of 200 patients who were diagnosed with epilepsy by a neurologist at Ankara Penal Institution Campus State Hospital between January 2013 and January 2014 were analyzed retrospectively. RESULTS: The mean age of study population was 32.6±10.1years. 181 of these patients were male (90.5%). 81 of 200 patients (40.5%) had a comorbid psychiatric disorder. The most common comorbid psychiatric disorders were depression (18.5%), anxiety (11%), and personality disorders (11%), respectively. CONCLUSION: The most common psychiatric comorbid disorders among prisoners diagnosed with epilepsy were depression and anxiety as general population with epilepsy whereas some disorders, personality disorder, substance dependence and bipolar affective disorders, were found to be more common among prisoners compared to the general population with epilepsy. It is crucial to question psychiatric symptoms and comorbidities while evaluating the patients with epilepsy, especially among prisoners.

Paliperidone: another treatment option for delusional parasitosis.

OBJECTIVE: Patients with delusional parasitosis (DP) have a fixed belief of being infested by small pathogens. Typical and atypical antipsychotics are widely used for treating DP. There are limited controlled trials about the treatment of DP and the most useful antipsychotic agent is still unknown. Paliperidone treatment for DP will be demonstrated through two cases. One of these cases had previously used pimozide but had not responded to treatment. Both cases had remission from symptoms with paliperidone. There are only two case reports published about paliperidone treatment for DP. CONCLUSION: Paliperidone appears to have promise in the treatment of DP; however, more case reports and controlled trials are required.

Does switching to another antipsychotic in patients with clozapine-associated granulocytopenia solve the problem? Case series of 18 patients.

UNLABELLED: Clozapine is a well-known drug that is used in treatment-resistant schizophrenia, but granulocytopenia, which may lead to a potentially fatal condition such as agranulocytosis, limit its use. The question about which antipsychotic should be used after a diagnosis of clozapine-associated granulocytopenia is difficult to answer, because antipsychotics other than clozapine may also have hematologic toxicity, or they may prolong clozapine-associated granulocytopenia. In this study, we aimed to find out the incidence of clozapine-associated granulocytopenia in our treatment sample and discuss suitable antipsychotic drug options in terms of hematologic toxicity, for management of clozapine-associated granulocytopenia. SUBJECTS: One thousand five hundred twenty-four schizophrenia patients, treated with clozapine, were included in the study. METHODS: Patients' white blood cell counts were monitored closely. Should granulocytopenia related to clozapine be diagnosed, clozapine was stopped immediately, and a new antipsychotic that the patient did not have a history of use was begun, according to the clinical profile of the patient. Persistent low white blood cell count after the 10th day of cessation of clozapine was accepted as prolongation effect. RESULTS: Of the 1524 schizophrenia patients, 18 were diagnosed to have granulocytopenia, which means that 1.18% of the clozapine users developed granulocytopenia related to clozapine. Six of the patients were treated with olanzapine, 5 patients were treated with quetiapine, 1 patient was treated with risperidone, and 6 patients were treated with amisulpride after clozapine is stopped. None of the patients treated with risperidone or amisulpride showed prolonged low white blood cell count. Two of the patients treated with olanzapine (33.3%) and 2 of the patients treated with quetiapine (40.0%) showed prolonged leukopenia. DISCUSSION: It is noteworthy that 33.3% of the patients treated with olanzapine and 40.0% of the patients treated with quetiapine showed prolonged leukopenia. This finding is also consistent with the literature that declares higher numbers of cases about prolongation of clozapine-associated granulocytopenia for olanzapine and quetiapine than risperidone and amisulpride. After switching to another antipsychotic drug, close monitoring of white blood cell count on a daily basis for the first 2 weeks should be continued until white blood cell counts are stabilized. Quetiapine and olanzapine especially need attention after clozapine-associated granulocytopenia. Further studies with larger series and longer follow-up should be carried out.

The importance of systematic genetic approach to familial schizophrenia cases and discussion of cryptic mosaic X chromosome aneuploidies in schizophrenia pathogenesis.

Abstract Objective. The aim of this study is to contribute to the understanding of schizophrenia genetics by using efficient algorithmic examination techniques including dysmorphic examination, karyotyping, and Fluoresence in situ hybridization (FISH). Methods. In this study we have investigated 20 familial schizophrenia patients from Turkey who had an affected first-degree relative. Dysmorphic examination of the schizophrenia cases and their relatives have been performed. High resolution banding (HRB), specific centromeric, subtelomeric and 22q11.2 region FISH probes were used for genotyping of patients. Results. Dysmorphic examination revealed ear, palate, nose, columella anomalies, and obesity in contributing patients, and the pale skin was noticed. The medical histories and clinical findings of two schizophrenia twins were almost identical. HRB study demonstrated the presence of 46,XX[55]/47,XXX[4]/48,XXXX[1] constitution in a paranoid schizophrenia case and 46,XX[67]/45,X[5] karyotype in her mother. FISH studies aiming subtelomeric chromosomal regions revealed no rearrangements and 22q11.2 regions were intact in all of the patients. Conclusions. The parental gonadal mosaicism lying at the origin of the mitotic aneuploidy may be the reason for mosaic X chromosome aneuploidies in our mother-daughter schizophrenia couple. Mosaic X chromosome aneuploidies may accompany schizophrenia cases and may contribute to pathogenesis of familial schizophrenia.

Depression and anxiety in patients with Behçet's disease compared with that in patients with psoriasis.

BACKGROUND: Behçet's disease (BD) is a chronic, episodic disease with an often devastating course. The aim of this study was to evaluate the depression and anxiety levels in patients with BD and to compare them with those in patients with psoriasis. METHODS: Patients were collected from the Dermatology Department, Faculty of Medicine, Gazi University, Ankara, Turkey. One hundred and twelve patients with BD and 95 patients with psoriasis were enrolled in the study. Patients were evaluated by Beck's depression inventory (BDI), Beck's anxiety inventory (BAI), automatic thoughts questionnaire (ATQ), and Beck's hopelessness scale (BHS). RESULTS: The group with BD had higher scores for BDI, BAI, ATQ, and BHS than the group with psoriasis (P < 0.05). Almost one-half of the patients with BD had depression. BAI only was higher in the younger BD group than in the corresponding psoriasis group, whereas all test scores were higher in the older BD group than in the corresponding psoriasis group. There was a strong correlation between the duration of BD and BDI, ATQ, and BHS scores, which was not observed in the psoriasis patients. BD increased the depression risk four-fold in this sample, and BD with a duration of over 3 years increased the depression risk 12-fold. CONCLUSIONS: In the present study, BD patients had higher levels of psychopathology than did psoriasis patients in terms of psychologic test scores. The duration of illness affected the severity of the psychiatric symptoms in the BD group, but not in the psoriasis group. The duration of illness was a major risk factor for the development of depression in BD. These findings indicate the need for early recognition of psychiatric symptoms in patients with BD.

Topiramate-induced psychotic exacerbation: case report and review of literature.

Background. Topiramate (TPM) is a new antiepileptic drug that is used mainly in the treatment of refractory partial epileptic seizures. There are some studies reporting TPM's effectiveness in the treatment and maintenance of some psychiatric illnesses such as acute mania, some other affective disorders, post-traumatic stress disorder and binge-eating disorder. On the other hand, it has been shown that TPM may cause mild to moderate cognitive impairment and is thought to be responsible for a series of neuro-psychiatric signs and symptoms. Some of the available articles that have mentioned the relationship of psychotic symptoms and topiramate usage are discussed. Objective. The present paper aims to discuss a case of psychotic exacerbation purported to occur after TPM administration and to review specifically the literature on TPM's potential for inducing psychotic symptoms. The patient presented here is thought to be an undiagnosed schizophrenia patient until his admission to our clinic (Department of Psychiatry, Gazi University Medical School) with TPM-exacerbated psychotic symptoms. Conclusions. The current findings are still subject to controversy because of the presence of both individual case reports and case series on the association between appearance of psychotic symptoms and TPM usage.

Prolongation of clozapine-induced leukopenia with olanzapine treatment.

Clozapine is a well-known antipsychotic to cause fatal agranulocytosis but there are only a few case reports about the risk of leukopenia and agranulocytosis associated with other atypical antipsychotics. Olanzapine has structural pharmacological similarities to those of clozapine and reports about haematological adverse effects of olanzapine include three groups: the first group includes cases of olanzapine-induced neutropenia, the second informing that olanzapine is safe after clozapine induced agranulocytosis and the third group forms prolongation of clozapine-induced leukopenia with olanzapine use. The aim of this paper is to report a case of prolongation of clozapine-induced leukopenia despite olanzapine treatment and discuss leukopenia caused by atypical antipsychotic use in the light of recent and limited literature.

Comparison of the effectiveness of reboxetine versus fluoxetine in patients with atypical depression: a single-blind, randomized clinical trial.

The atypical subtype of depression appears to be well validated and common, and it is unique among Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) in that it includes a personality trait, rejection sensitivity, as a criterion. Drug selection remains a challenge for the clinician who treats patients with this subtype of depression. Noradrenergic antidepressants have been thought to have prominent effects in improving such symptoms as loss of motivation, drive, and energy, which are among the core symptoms of patients with atypical depression. Thus it can be speculated that noradrenergic antidepressants might be superior to serotonergic antidepressants in reducing symptoms of atypical depression. This is the first study to compare the efficacy of fluoxetine, a selective reuptake inhibitor of serotonin, and reboxetine, a selective reuptake inhibitor of norepinephrine, in the treatment of patients with atypical depression. A total of 43 patients with atypical depression according to DSM-IV were randomly assigned to receive fluoxetine or reboxetine over an 8-wk clinical trial. Patients with a Structured Clinical Interview for DSM-IV diagnosis of personality disorder accounted for 54% of those with atypical depression in this sample. Patients with personality disorders were typically young and were unable to maintain a marriage. Adverse effects such as dry mouth, sweating, headache, and urinary retention were more prominent in the reboxetine group than among those given fluoxetine. Although a greater number of patients treated with reboxetine dropped out of treatment, the pattern of response was very similar for both drugs, and both were effective in reducing symptoms of depression. The presence of a personality disorder in patients with atypical depression did not affect the response to either of the antidepressants. These findings might suggest that drugs with norepinephrine or a 5-hydroxytryptamine mechanism of action might act through a common pathway, resulting in a similar response in terms of core symptoms of depression. If tolerability, efficacy, and cost-effectiveness of antidepressants are considered, the best antidepressant is the one that can be used by the patient, whether or not a personality disorder accompanies atypical depression.