Facial emotion recognition deficits in patients with bipolar disorder and their healthy parents.

BACKGROUND: There is evidence on deficits in facial emotion recognition (FER) in patients with bipolar disorder (BD), and these deficits may be present in individuals with genetic risk for BD. This study investigated facial emotion identification and discrimination abilities in patients with BD, their parents, and healthy controls. MATERIALS AND METHODS: This study included 38 patients with bipolar I disorder and 30 healthy controls for patients as well as 30 healthy mothers and 30 healthy fathers of these patients and 30 healthy controls who matched the mothers and fathers for age, gender, and education (total 188 participants). Facial Emotion Identification and Discrimination Tests were applied to all participants; the Hamilton Depression Rating Scale and Young Mania Rating Scale were applied to patients and their control group. RESULTS: Facial Emotion Identification and Discrimination Test scores of patients and their parents were reasonably lower than their matching control groups. Moreover, we found that difficulty in FER affected more emotions in mothers than in fathers and mothers performed significantly worse than patients in the identification of angry and embarrassed faces. CONCLUSION: These findings indicate that parents of patients with BD have impairment with recognizing facial emotions and suggest that there may be an association between FER of patients with BD and that of their mothers.

Evaluation of clinical and suicidal behavior characteristics among urban, Turkish middle-age depressive patients with comorbid attention deficit hyperactivity disorder.

BACKGROUND: In the presence of attention deficit hyperactivity disorder (ADHD) together with additional psychiatric diseases, the treatment process and prognosis of both ADHD and psychiatric comorbidity are adversely affected. AIMS: The aim of this study is to compare the characteristics concerning suicidal behavior of the patients diagnosed with major depressive disorder either having (ADHD+) or not having (ADHD-) adult ADHD comorbidity and their responses to depression treatment. MATERIALS AND METHODS: Ninety-six inpatients were included in the study. Sociodemographic data form, the Hamilton Depression Rating Scale (HDRS), the Wender Utah Rating Scale (WURS), the Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale, and the Personal and Social Performance Scale (PSP) were applied to the cases. RESULTS: HDRS scores were found to be significantly high (P < 0.000) in the ADHD+ group during admission and discharge. However, there was no difference found in terms of PSP scores (P = 0.46) during discharge. In the ADHD+ group, the depressive episode started at an earlier age (P < 0.011). The idea of suicide (P < 0.018) and suicidal attempts (P < 0.022) was found to be higher in this group compared to the ADHD- group. ADHD+ patients had more suicidal attempts requiring more medical intervention (P < 0.001). CONCLUSION: Depression starts at an early age in individuals with comorbid ADHD diagnosis, and the progress of the depression treatment changes negatively. This patient group is at greater risk in terms of suicidal behavior. Therefore, it should be considered by the clinicians that ADHD can associate with depression while making the follow-up plans for the cases diagnosed with depression.

Impulsivity, Sensation Seeking, and Decision-Making in Long-Term Abstinent Cannabis Dependent Patients.

INTRODUCTION: In contrast to several studies that examined different domains of neurocognitive functions in long-term abstinent cannabis users, there are few studies examined impulsivity in cannabis users with prolonged abstinence. The aim of this study was to test whether impulsivity and sensation seeking traits and impulsive decision-making are transient or enduring in patients with cannabis dependence who were abstinent for at least 1 month. METHODS: The study included 30 patients with cannabis dependence (CDP) who had been abstinent for at least 1 month and 30 healthy controls. All the participants were male and the two groups were matched for age and duration of education. RESULTS: As a result of Iowa Gambling Task (IGT) evaluation, there was no significant group (CDP vs. control) by block interaction in IGT performance (p=0.680). CDP showed significantly higher Barratt Impulsiveness Scale-11 (BIS-11) total (p=0.006), BIS-11 non-planning (p=0.006) and Zuckerman Sensation Seeking Scale experience seeking subscale (p=0.001) scores compared with controls. CONCLUSIONS: This is the first study to investigate decision-making, self-report impulsivity and sensation seeking in long-term abstinent CDP. Our findings suggest that both self-report impulsivity and experience seeking may reflect a stable trait in CDP but not deficits on decision-making. This suggestion is consistent with the hypothesis that elevated impulsivity and sensation seeking traits may lead to addiction when they occur together rather than alone.

Abnormal white matter integrity in synthetic cannabinoid users.

Synthetic cannabinoids have become increasingly popular in the last few years especially among adolescents and young adults. However, no previous studies have assessed the effects of synthetic cannabinoids on the structure of the human brain. Understanding the harms of synthetic cannabinoid use on brain structure is therefore crucial given its increasing use. Diffusion tensor imaging (DTI) was performed in 22 patients who used synthetic cannabinoids more than five times a week for at least 1 year and 18 healthy controls. Fractional anisotropy (FA) was significantly reduced in the cannabinoid group compared to controls in a cluster of white matter voxels spanning the left temporal lobe, subcortical structures and brainstem. This cluster was predominantly traversed by the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, fornix, cingulum-hippocampus and corticospinal tracts. Long-term use of synthetic cannabinoids is associated with white matter abnormalities in adolescents and young adults. Disturbed brain connectivity in synthetic cannabinoid users may underlie cognitive impairment and vulnerability to psychosis.

[Clozapine and Olanzapine Associated Atrial Fibrillation: A Case Report]. / Klozapin ve Olanzapin ile Iliskili Atriyal Fibrilasyon: Olgu Sunumu.

OBJECTIVE: Atrial fibrillation is a serious side effect of antipsychotic drugs, it is very rare but can be fatal. In this case report, a subject who developed an atrial fibrillation after receiving clozapine and olanzapine has been presented. CASE: A 49 year-old female patient with a 10-year history of schizophrenia with no additional disease history was admitted to the hospital with the diagnosis of schizophrenia. Clozapine was started to be given as 12,5 mg/day and then it was gradually increased for the patient. After the development of atrial fibrillation when the clozapine dose was at 100 mg/day (25th day of the treatment), the patient was monitored with daily ECG and no medicine was given in this period. Then, after one week, the clozapine was started to be given as 12.5 mg/day and it was increased to a dose of 100 mg per day. Meanwhile, a single dose of 10 mg of olanzapine velotab was given to the patient with no cardiac problems to prevent agitation and atrial fibrillation developed again after that. Holter ECG was within normal limits. Clozapine treatment was discontinued when the treatment dose was 250 mg/day, because atrial fibrillation developed again. After a drug-free one week, atrial fibrillation did not occur during the following haloperidol, risperidone, quetiapine treatments. CONCLUSION: It is especially very important to monitor the cardiac side-effects in the patients who are using atypical antipsyhotic drugs and ECG monitorization is equally important. More studies are needed to be made towards the research of the antipsychotic arrhythmia relationship.

Prevalence of Intimate Partner Violence and Associated Factors.

INTRODUCTION: The aim of the present cross-sectional study was to investigate the prevalence of intimate partner physical violence among depressive Turkish women, as well as the association of intimate partner physical violence with attachment patterns, childhood traumas, and socio-demographic factors. METHODS: The study included 100 women diagnosed with depressive disorder and 30 healthy women. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV axis I disorders, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Adult Attachment Style Questionnaire (AASQ), and Childhood Trauma Questionnaire (CTQ) were used for clinical assessment. RESULTS: It was found that 64% of the women diagnosed with depression were suffering from intimate partner physical violence. In these women, the severity of depression and anxiety symptoms was higher, suicidal ideation and suicide attempts were more common, and the diagnosis of double depression was more prevalent. These women also achieved higher scores in the avoidant and ambivalent subscales of AASQ and higher total scores and higher scores in the physical abuse subscale of CTQ. The partner's and the woman's experiences of physical violence in their families during their childhood predicted intimate partner physical violence for women suffering from depression. CONCLUSION: The investigation of domestic violence contributes to the treatment of depression and also to the recognition and prevention of domestic violence that has profound effects on successive generations.

Reliability and Validity of the Turkish Version of Abdel-Khalek's Death Anxiety Scale among College Students.

INTRODUCTION: Although death anxiety is considered a universal phenomenon, attitudes toward death may vary across populations that differ in terms of religion and culture. Abdel-Khalek's Death Anxiety Scale (ASDA) was developed on the basis of the rationale that there are specific concepts related to death and after death in Muslim populations. This study aims to translate and adapt ASDA in the Turkish population, examine its validity and reliability, and to compare its psychometric properties with the widely used Templer's Death Anxiety Scale (DAS). METHODS: A total of 220 medical students were included in the study. The Turkish version of ASDA, DAS, and Hospital Anxiety and Depression Scale were used for data collection. RESULTS: Cronbach's alpha coefficients were .86 for ASDA and .66 for DAS. Analysis by principal components with varimax rotation produced five factors for ASDA that explained 65.6% of total variance. ASDA and DAS were highly correlated with each other (r=.68, p<.001). CONCLUSION: The results of this study indicate that the Turkish version of Abdel-Khalek's Death Anxiety Scale is a reliable and valid instrument. The Turkish version of ASDA revealed better psychometric properties than DAS. This finding may reflect specific cultural and religious attitudes toward death or may result from more comprehensible language use in ASDA.

Abnormal white matter integrity in long-term abstinent alcohol dependent patients.

A number of diffusion tensor imaging (DTI) studies have reported substantial white matter (WM) abnormalities in alcohol-dependent patients. These studies were usually performed in recovering alcohol-dependent patients who had been abstinent for days to several weeks. The current study was designed to examine WM microstructure and decision-making in a sample of long-term abstinent alcohol-dependent patients. The study included 12 subjects with alcohol dependence who had been abstinent for at least 6 months before testing and scanning and 13 healthy control subjects. The Iowa Gambling Task (IGT) was used to measure decision-making. We found that the long-term abstinent alcohol-dependent group had significantly higher radial and axial diffusivity (RD and AD, respectively) values in frontal, temporal and parietal WM than was found in the healthy control group despite showing no difference in fractional anisotropy (FA) values in comparison to controls. In conclusion, we found widespread WM changes in long-term abstinent alcohol-dependent patients compared with healthy controls. Our findings suggested that AD and RD should be included in analyses of DTI data in addition to the more commonly studied FA. In the current study, FA values of the detoxified alcoholics had recovered and were comparable to those of the controls, whereas significant changes in AD and RD were still observed in some clusters in the frontal, parietal and temporal lobes of detoxified alcoholics even after 27.8 months.

[Mania associated with quetiapine treatment]. / Ketiapin Kullanimi ile iliskili mani: olgu sunumu.

Presently, the use of atypical antipsychotics is getting increasingly widespread. There are several mania/hypomania cases that have been associated with atypical antipsychotic treatment that also display antimanic, antidepressive and anxiolytic effects in addition to their antipsychotic effects. In this study, a case of schizophrenia in which manic symptoms developed after increasing the dosage of quetiapine to 300 mg/day, and subsequently disappeared after cessation of treatment is presented. Although the blockage of 5HT2 receptors and the disinhibition of frontal dopamine secretion seemed to be the reasons for the development of the mania/hypomania related to atypical antipsychotics, the mechanism is not clear. During the use of atypical antipsychotics, clinicians should be cautious to patients' mood fluctuations.

Abnormal white matter integrity and decision-making deficits in alcohol dependence.

To date, there is no study that explored the correlation of microstructural changes in the whole brain white matter (WM) and decision-making in alcohol dependent patients (ADP). In the present study, we applied Tract Based Spatial Statistics (TBSS) to study WM changes in ADP compared with healthy controls. We also tested whether there was any relationship between WM integrity and decision-making in ADP. The study included 17 inpatient ADP who had been abstinent for at least 2 weeks before testing and scanning and 16 healthy control subjects. The Iowa Gambling Task (IGT) was used to measure decision-making. Results for the IGT showed a significant group (ADP vs. control) by block interaction. Follow-up univariate analyses of variance showed that the groups were significantly different in the last 20 trails. Four significant clusters were found in which fractional anisotropy was significantly lower in ADP than in control subjects, including the corpus callosum and parietal, occipital and frontal regions. We found significant correlations between impaired IGT performance in the last 20 trials and WM integrity in these regions. Together, these results might help to explain observed decision making deficits in ADP.

[The perceived burden of care and its correlates in schizophrenia]. / Sizofrenide Ailenin Yükünü Etkileyen Etmenler.

OBJECTIVE: The present study aimed to investigate the perceived level of burden of care and its correlates in family members of schizophrenia patients. METHOD: The study included 239 schizophrenic patients that were followed-up at the psychiatric outpatient clinics of Izmir Ataturk Education and Research Hospital, and Celal Bayar University Medical School, and 239 of their primary caregivers. Patients were assessed using the Positive and Negative Syndrome Scale (PANNS), Global Assessment of Functioning Scale (GAF), Social Functioning Scale (SFS), Brief Cognitive State Examination (BCE), and UKU Side Effect Rating Scale. Their primary caregivers were assessed using the Perceived Family Burden Scale (PFBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Caregiver PFBS scores ere correlated with male patients, female caregivers, inadequate social support, economic difficulty, the presence of chronic physical disorder in the caregivers, patient violence toward the caregivers, total duration of illness, the number of patient hospitalizations, PANNS total and subscale scores, and SFS, BDI, and BAI scores. Perceived burden of care was predicted by the severity of the patients' positive symptoms, SFS independence/competence and interpersonal functioning subscale scores, and caregivers' anxiety and depression levels. CONCLUSION: In order to decrease the burden of care in schizophrenia we recommend effective management of patient symptoms, enhancement of patient social functioning, interventions that target caregivers with high levels anxiety and depression, and social support provided by healthcare professionals.

Evaluation of depressive symptoms in acne patients treated with isotretinoin.

BACKGROUND: There have been concerns about the association between isotretinoin therapy and depressive symptoms. OBJECTIVE: The objective of this study is to evaluate whether there is an association between isotretinoin therapy and the onset of depression. METHODS: A total of 50 patients with moderate to severe recalcitrant acne and 30 healthy volunteer people were enrolled in the study. Depressive symptoms and anxiety status were assessed at baseline and then 1 and 4 months after the initiation of isotretinoin treatment. RESULTS: We detected improvement in Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores in acne patients after isotretinoin therapy. Statistically significant improvement in depressive symptoms began at the first month. Improvement in anxiety was detected later than the improvement in depressive symptoms and a statistically significant difference was detected between the first and the second follow-up. CONCLUSIONS: Our results provide no relationship between isotretinoin use and depression in acne patients.

[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.

Acute phase results from STORM, a multicountry observational study of bipolar disorder treatment and outcomes.

OBJECTIVES: This prospective observational study examined the outcomes associated with the treatment of bipolar mania in clinical practice settings in a diverse range of countries: Bosnia, Slovenia, Slovakia, Egypt, Saudi Arabia and Turkey. Particular emphasis was placed on investigating outcomes associated with treatment regimens including and excluding the atypical antipsychotic olanzapine. SUBJECTS AND METHODS: In- and outpatients initiating or changing oral medication for the treatment of bipolar mania were grouped into two treatment cohorts: (1) olanzapine (N=569), and (2) non-olanzapine (N=325). Clinical outcome measures included change in Clinical Global Impressions-Bipolar Version Severity of Illness scale (CGI-BP), Young Mania Rating Scale (YMRS) and Hamilton Depression Rating scale- 5 item (HAMD-5) scores, and response and remission rates. Outcomes were analysed by conventional linear or logistic regression, adjusted for potential confounders, using last observation carried forward (LOCF) at endpoint, and a marginal structural model (MSM) approach to account for treatment switching. Results from the 12-week acute phase are presented. RESULTS: Clinical improvements were observed in both cohorts. While no marked differences were apparent between the groups in adjusted mean baseline to LOCF endpoint change, longitudinal analysis of these variables using MSM averaged over all visits indicated greater improvements in the olanzapine versus non-olanzapine cohort in CGI-BP Overall (-0.26, p<0.001), CGI-BP Mania (-0.19, p<0.001), CGI-BP Depression (-0.10, p=0.003), CGI Psychosis (-0.14, p=0.001), YMRS (-1.70, p<0.001), and HAMD-5 (-0.40, p<0.001) scores. CONCLUSIONS: Inclusion of olanzapine after initiating or switching treatment for bipolar mania appeared to be beneficial during treatment in terms of symptom improvement.

Depression and anxiety levels in infertile Turkish women.

OBJECTIVE: To investigate the levels of anxiety-depression in women with infertility and to investigate the relationship between psychologic symptoms, course of treatment and cultural factors. STUDY DESIGN: The study included 107 women with primary infertility in the index group and 63 healthy women in the control group. The Hospital Anxiety Depression Scale was applied to both groups to evaluate psychologic symptoms. The same scale was applied once more after 3 months to the infertility group. RESULTS: There was no significant difference in the level of depression-anxiety between the 2 groups. The severity of psychologic symptoms was greater in those in the infertility group who had attempted nonmedical solutions, who were under pressure from their husbands' families because of their infertility and who reported "bad" relations with their husbands. At the end of the 3 months, the group of patients who achieved pregnancy showed significantly lower levels of anxiety and depression scores than the group of patients who did not. Age, attempts at nonmedical solutions, pressure from the husband's family because of infertility and anxiety level at the start of the study were variables that predicted pregnancy negatively. CONCLUSION: It can be useful to take cultural factors into account in evaluating the mental health of infertile women.

T2 hyperintensities in bipolar patients and their healthy siblings.

BACKGROUND: This study investigates the frequency of hyperintensities, which are common in bipolar disorder, in sufferers' siblings who are free of bipolar disorder and to ascertain whether these lesions reflect any familial characteristics. It offers an assessment of the relationship between these lesions and clinical characteristics. METHODS: The study group consisted of 12 patients with bipolar disorder, their siblings who had no history of mental disorder, and a matched control group. All three groups were assessed using SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) for diagnosis, and MRI (magnetic resonance imaging) for signal hyperintensity. RESULTS: No periventricular white matter lesions were encountered in any groups. It was found that in the patients and siblings, the location was in the right cerebral hemisphere in the deep white matter, whereas it was in the left cerebral hemisphere for the control group. Only in the patient group were lesions detected in subcortical white matter in the right cerebral hemisphere. The lesions were localized in the fronto-parietal area. Considering the brain as a whole, more hyperintensities were detected in the patient group compared to the other two groups. The onset of the disorder with a manic episode was increasing probably in the presence of hyperintensities. CONCLUSIONS: Despite being alike in terms of age, more hyperintensities were detected in the patient group than in the siblings and control groups. Contrary to the control group, however, hyperintensities were localized in the right cerebral hemisphere in both the patients and the siblings groups. Hyperintensities seen in the left cerebral hemisphere yield a nonspecific impression. Siblings who have hyperintensities in the right cerebral hemisphere should be followed up and investigated with regard to bipolar disorder.

Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction.

BACKGROUND: Thyroid dysfunction may impair the quality of life (QoL) and may cause psychological symptoms. The aim of this study is to investigate prospectively the effects of thyroid dysfunction on quality of life, levels of depression/anxiety and the changes in these variables after treatment. METHODS: A total of 160 subjects, consisting of an overt hypothyroidism group (n = 33), a subclinical hypothyroidism group (n = 43), an overt hyperthyroidism group (n = 51), a subclinical hyperthyroidism group (n = 13), and a healthy control group (n = 20) were included in the study. All groups were evaluated with the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Short Form-36 (SF-36), and Brief Disability Questionnaire (BDQ). Health-related quality of life (HRQL) was measured by SF-36. RESULTS: Anxiety and depressive symptoms were more severe in patients with overt hypo- and hyperthyroidism (p <0.001). The QoL was worse in overt or subclinical hyper- and hypothyroidism groups than in the control group [p = 0.013 for physical composite score (PCS); p = 0.002 for mental composite score (MCS)]. Psychological symptoms and QoL were improved in overt and subclinical hypothyroidism and overt hyperthyroidism groups as a result of the treatment. The overt hyper- and hypothyroidism groups showed more improvement than the subclinical groups. CONCLUSIONS: This study suggests that restoration of euthyroidism is accompanied by improvement on QoL and psychological symptoms in all groups except the subclinical hyperthyroidism group. Controlled, randomized studies in larger groups are, however, necessary.

From antepartum to postpartum: a prospective study on the prevalence of peripartum depression in a semiurban Turkish community.

OBJECTIVE: To examine the prevalence of depression in the last trimester of pregnancy and within the first 6 months postpartum, to determine whether there is an association between antepartum and postpartum depression and to investigate the risk factors prospectively in a cohort of Turkish women. STUDY DESIGN: In a prospective, community-based, cohort study, 125 women who expected to give birth during the first 6 months of 2002 (January 1, 2002-June 30, 2002) were included. Depression was measured at 36-38 weeks antepartum and then again at 5-8, 10-14 and 20-26 weeks postpartum using the Edinburgh Postnatal Depression Scale. A questionnaire that was devised to collect data on sociodemographic and clinical information on the women was applied. RESULTS: The prevalence of depression was highest in pregnancy (21.6%) and declined gradually in the follow-up period (respectively, 16.8%, 14.4% and 9.6%). Antepartum depression was a statistically significant risk factor during the 6 months postpartum in each of the 3 assessments. In the logistic model, past history of mental illness, history of mental illness in first-degree relatives and adverse life events were associated with antepartum depression; low income, adverse life events and a poor relationship with the husband were associated with postpartum depression. CONCLUSION: Evaluations made in'the last trimester of pregnancy should be very helpful in diagnosing and preventing depression in women at high risk.

Comparison of fluoxetine and paroxetine in type II diabetes mellitus patients.

BACKGROUND: This study aims to investigate the efficacy of fluoxetine and paroxetine on the levels of depression-anxiety, quality of life, disability, and metabolic control in type II diabetes mellitus (DM) patients. METHODS: The patients were first applied the Hospital Anxiety-Depression Scale (HADS). After a psychiatric interview with patients who had scores above the cut-off point, those who were diagnosed as having a major depressive disorder according to DSM-IV criteria were applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Twenty three patients who scored 16 or above on the HDRS were included in the study and given the Short Form-36 (SF-36), and the Brief Disability Questionnaire (BDQ) and HbA1c levels were measured. Patients were randomized on 20 mg/day fluoxetine or 20 mg/day paroxetine treatment. The patients were evaluated with the same scales at the 2(nd), 4(th), 6(th), and the 12(th) weeks. RESULTS: Both groups showed a statistically significant decrease in HDRS, HARS, and BDQ scores with comparison to the index assessment. At the end of treatment, though not statistically significant, a decrease was observed in HbA1c values of the fluoxetine-administered group. CONCLUSIONS: Fluoxetine and paroxetine effectively reduce the severity of major depressive disorder in type II DM patients. There is need for further and longer-lasting monitoring studies with more patients in order to determine whether there is any difference in terms of their effects on glycemic control.

Effects of tibolone on the quality of life, anxiety-depression levels and cognitive functions in natural menopause: an observational follow-up study.

The effects of tibolone on the quality of life (QoL), depression-anxiety levels and cognitive functions were investigated. Seventeen women received tibolone and 25 women did not receive any medication. At the end of the 6-month follow-up period, the QoL was better in the tibolone group in the area of mental health. Disability, anxiety symptoms, menopausal symptoms were significantly reduced in this group.