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.

A Case Report of the First Propofol Addiction in Turkey.

Propofol is a potent anaesthetic drug and also an effective sedative agent. Also, propofol may be used for non-anaesthetic purposes such as the treatment of seizures, migraine and tension headache in clinical practice. It has been abused, particularly among healthcare providers with high mortality rate. This report presents the case of a propofol-dependent patient who was an emergency medicine doctor with no difficulties in obtaining the drug. He himself visited our clinic for the treatment of propofol dependence. We started the patient's treatment with pharmacotherapeutic medicines and individual psychotherapy. Fourteen days after starting the therapy, the patient was discharged from hospital on his own will and he did not attend the follow-up visits in the outpatient clinic. Then, we were informed of his death, which was suspected to have occurred owing to drug intoxication in the hospital in which he worked. Nevertheless, the reason of death was important; the importance of this case report is to provide information regarding the drug's dependence profile. This is the first case report indicating propofol dependence in Turkey. Because of its easy access, rapid onset time and short duration of action, propofol dependence is increasing. We think that adding propofol to the controlled drug list and improving the knowledge of the clinicians regarding its abuse potential may limit the dependence cases.

Association of depression with markers of nutrition and inflammation in chronic kidney disease and end-stage renal disease.

BACKGROUND: Depression, which is the most common psychological disorder among patients with end-stage renal disease (ESRD), is commonly associated with poor oral intake which can aggravate anemia and malnutrition in chronic dialysis patients. The objective of this study is to explore the association between depression and C-reactive protein (CRP), ferritin, serum albumin and hemoglobin/hematocrit in patients with chronic kidney disease (CKD) and ESRD. METHODS: Sixty-eight patients on hemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 26 patients with CKD on conservative management were enrolled in this study. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders-Clinician Version (SCID-CV). The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum CRP (nephelometric method), ferritin (immunometric method), albumin (bromcresol green technique), hemoglobin, and hematocrit levels were measured. RESULTS: A total of 34 of 141 patients (24.1%) had depression. The mean BDI score was higher in depressive patients compared to nondepressive patients. In HD patients the frequency of depression and CRP and ferritin levels were higher than in other groups. Patients with depression had lower hemoglobin, hematocrit and serum albumin levels and higher CRP and ferritin levels than patients without depression. The BDI score showed a positive correlation with serum CRP and ferritin levels, but a negative correlation with the serum albumin level. CONCLUSIONS: We observed that CKD and ESRD patients with anemia, hypoalbuminemia and higher serum CRP and ferritin concentrations should be evaluated for depression after potential somatic causes have been eliminated.

Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C.

OBJECTIVE: The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL). METHODS: The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form--36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group. RESULTS: 43.9% of the patients had hepatitis B, 56.1% hepatitis C. A psychiatric diagnosis was made in 48.6%, of which 15% was depression. No significant difference was found in the rate of psychiatric diagnosis between hepatitis B and hepatitis C patients. Hepatitis B and C patients were found to vary significantly (p < 0.001) from the control group on all subcategories of quality of life criteria. Psychiatric morbidity (mainly depression) was the major variable on lowering HRQL (p = 0.000). CONCLUSIONS: Chronic hepatitis B and C patients presented a high rate of psychiatric disorder. HRQL was significantly decreased in patients with psychiatric morbidity.