Ghrelin and lipid levels in panic disorder before and after treatment and their relationship with agoraphobia.

BACKGROUND: We aimed to evaluate serum ghrelin (GHR) levels and lipid profile in panic disorder (PD), with and without agoraphobia, and to compare these parameters before and after treatment. SUBJECTS AND METHODS: The GHR and lipid profiles were measured in blood samples taken from 31 PD patients with agoraphobia, 22 PD patients without agoraphobia, and 53 control group subjects. 23 of the 53 patients who were prescribed 20 to 40 mg/day paroxetine had continued treatment. The 23 patients who had continued treatment were measured again at the end of twelve weeks. RESULTS: The GHR and triglyceride (TRG), total cholesterol (Total-C), low-density lipoproteins (LDL-C), and very low-density lipoproteins (VLDL-C) levels were higher in the PD with agoraphobia group than the PD without agoraphobia and control groups. The 23 patients that had continued their treatment were re-evaluated, and the serum GHR, Total-C levels, and BMI after treatment were significantly decreased, compared to the values before treatment. CONCLUSIONS: There may be a pathophysiological relationship between the GHR and lipid profiles that interact with each other in PD. In fact, this relationship was more marked in PD with agoraphobia than in PD without agoraphobia.

Follow-up study of children whose mothers were treated with transcranial magnetic stimulation during pregnancy: preliminary results.

OBJECTIVES: The purpose of this study is to determine the impact of repetitive transcranial stimulation (rTMS) treatment during pregnancy on neurodevelopment of children. MATERIALS AND METHODS: Women who were treated with rTMS during pregnancy and delivered liveborn children between 2008 and 2013 were selected. A control group consisted of children whose mothers had a history of untreated depression during their pregnancy (N = 26). Early developmental characteristics of all the children in the study were evaluated, and their developmental levels were determined using the Ankara Developmental Screening Inventory. RESULTS: The mean age of the children in the rTMS treatment group was 32.4 months (range 16-64 months), and that of the untreated group was 29.04 (range 14-63 months). Jaundice (N = 2) and febrile convulsion (N = 1) were the reported medical conditions in the children of the rTMS-treated group; jaundice (N = 3) and low birth weight (N = 1) were reported in the untreated group. In the rTMS group, mothers' perception of delay in language development was observed, but there were not any statistically significant differences in the prevalence rate compared with the untreated group (OR = 0.38; 95% CI 0.0860-1.6580). CONCLUSIONS: Our results suggest that rTMS exposure during pregnancy is not associated with poorer cognitive or motor development outcomes in children aged 18-62 months. Although language development as reported by the mothers was found to be poorer than expected in the rTMS-treated group, the delay was found to be similar to the language delay observed in offspring of untreated mothers, as reported in previous studies of prenatal depression treated with selective serotonin reuptake inhibitors.

Therapeutic drug monitoring: perspectives of psychiatrists in Turkey.

OBJECTIVES: Although the medical and economic implications of therapeutic drug monitoring have been intensely discussed over the past years, little is known about the experiences and attitudes of psychiatrists in their clinical practice. The aim of this study was to investigate psychiatrists' daily practice with therapeutic drug monitoring in Turkey. METHODS: A nation-wide cross-sectional survey among adult and child psychiatry specialist psychiatrists in Turkey was conducted. RESULTS: We found that 98.4% (n = 380) of the study participants used TDM in clinical practice and 1.6% (n = 6) did not. However, TDM use is limited to mood stabilizers (lithium 96.3%, valproate 97.6%) to a great extent. Only a small number of psychiatrists perform TDM for other psychotropic drugs, e.g., clozapine 2.4%, tricyclic antidepressants 1.3%, benzodiazepines 1.1%, and selective serotonin reuptake inhibitors 0,8%. CONCLUSIONS: Most of the psychiatrists in Turkey have a positive attitude toward use of therapeutic drug monitoring although there is also a considerable difficulty to reach services for the therapeutic drug monitoring of psychotropics other than mood stabilizers.

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia / Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento

Background: Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective: The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods: In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion: Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse...

Contexto: A eletroconvulsoterapia (ECT) tem mostrado ser um tratamento seguro e eficaz para esquizofrenia. No entanto, o número de estudos que avaliam a utilização contínua de ECT em pacientes com esquizofrenia e a resposta parcial ao tratamento farmacológico é limitado. Objetivo: O objetivo deste estudo é avaliar a eficácia da ECT de continuação na prevenção de recaída em pacientes com esquizofrenia resistente ao tratamento. Métodos: Nesta análise retrospectiva, pacientes com esquizofrenia (n = 73) foram alocados em três grupos: pacientes que receberam apenas o tratamento AP (somente AP), pacientes que receberam um curso agudo de ECT durante a hospitalização (aECT+AP) e pacientes que receberam um curso agudo de ECT durante a hospitalização e ECT de continuação (a-cECT+AP). Esses três grupos foram comparados de acordo com a pontuação atribuída na Positive and Negative Syndrome Scale (PANSS) e na Brief Psychiatric Rating Scale (BPRS). Resultados: De acordo com a comparação dos grupos, somente em AP, aECT+AP e a+cECT+AP, em termos de PANSS e BPRS, após descarga no primeiro, terceiro e sexto mês, as pontuações na PANSS no terceiro e sexto mês no grupo a+cECT+AP foram estatística e significativamente menores do que nos outros dois grupos. Conclusões: Embora este estudo mostre limitações causadas pela análise retrospectiva de prontuários, os resultados sugerem que a continuação da ECT em combinação com antipsicóticos é mais eficaz do que somente os antipsicóticos, na prevenção da recaída em pacientes com diagnóstico de esquizofrenia que responderam ao curso agudo de ECT...

Effect of valproate on the plasma concentrations of aripiprazole in bipolar patients.

OBJECTIVE: There is very limited documentation available on the effects of valproate co-medication on the pharmacokinetics of aripiprazole in a naturalistic setting. The aim of the present study was to investigate the effect of co-medication with valproate on serum concentrations of aripiprazole in bipolar disorder patients in a clinical setting. METHOD: Plasma samples of bipolar disorder patients (n = 69) on a stable dose of aripiprazole 20 mg/day were analyzed by a liquid chromatography-mass spectrometry method in a routine therapeutic drug monitoring setting. Therapeutic drug monitoring was done for the entire study group before and after valproate co-administration. RESULTS: We observed a statistically significant difference between the aripiprazole monotherapy and aripiprazole-valproate combination with respect to total aripiprazole plasma levels (p < 0.01). However, no statistically significant differences were noted in aripiprazole levels between the first week and the second week of valproate co-administration. CONCLUSION: In conclusion, concurrent treatment with valproate resulted in changes in the total aripiprazole plasma levels by 23%. But a lower total aripiprazole concentration during co-medication with valproate, caused by protein binding displacement, is reported being clinically insignificant in previous studies. The results from these studies are important in order to clarify clinical safety and efficacy.

Analysis of manganese superoxide dismutase (MnSOD: Ala-9Val) and glutathione peroxidase (GSH-Px: Pro 197 Leu) gene polymorphisms in mood disorders.

We investigated the etiopathogenetic role of manganese superoxide dismutase (MnSOD) (Ala-9Val) and glutathione peroxidase (GSH-Px) (Pro 197 Leu) gene polymorphisms in patients diagnosed with major depressive disorder (MDD) and bipolar I disorder (BD). Eighty patients with MDD, 82 patients with BD (total 162 patients) and 96 healthy controls were enrolled in this study and genotyped using a Real Time-Quantitative Polymer Chain Reaction (RT-qPCR)-based method. The patients with BD and MDD and the controls had a similar distribution of the genotypes and alleles in the Ala-9Val MnSOD gene polymorphism. Comparison of the MDD group and control group regarding the Pro 197 Leu GSH-Px gene polymorphism revealed similar genotype distribution but different allele distribution. The BD group and control group were similar both for genotypes and for alleles when compared regarding the Pro 197 Leu GSH-Px gene polymorphism. The combined analysis (MDD plus BD) also failed to find any association between the Ala-9Val MnSOD and Pro 197 Leu GSH-Px gene polymorphism. Although small statistical power of the current study the significant difference between patients with depression and the control group for the Pro 197 Leu GSH-Px polymorphism indicates that the distribution of these alleles may have a contribution in the physiopathogenesis of depression. One of the limitation of the current study is that the sample size is too small. Understanding of the exact role of Pro 197 Leu GSH-Px polymorphism in the development of depression needs to further studies with more sample size and high statistical power.

The effect of agoraphobia on oxidative stress in panic disorder.

We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.

The changes in tear film parameters and impression cytology in heavily drinking men.

PURPOSE: To evaluate the tear film function and ocular surface changes in heavily drinking men. METHODS: This prospective case-control study involved 35 male subjects with heavy alcohol consumption (group 1) and 35 age- and sex-matched control subjects (group 2). Best-corrected visual acuity measurement, slit-lamp examination, Schirmer I test, tear film break-up time (BUT) measurement, and conjunctival impression cytology were performed in all subjects. The results were compared between the 2 groups. RESULTS: The mean Schirmer I test results in group 1 and group 2 were 8.31 ± 3.56 mm and 13.17 ± 5.71 mm, respectively, and the mean BUT values were 9.22 ± 3.10 seconds and 13.20 ± 4.04 seconds, respectively. The mean Schirmer I and BUT results were statistically lower in group 1 than in group 2 (P < 0.0001). The mean impression cytology scores in group 1 and group 2 were 2.08 ± 0.78 and 1.37 ± 0.94, respectively. A statistically significant difference was noted between the study and control groups for the grading of cytological changes (P = 0.001). CONCLUSIONS: Our data showed that heavily drinking men have decreased tear production, tear film instability, and significant degeneration of the ocular surface epithelium when compared with normal subjects.