Withdrawal-Emergent Dyskinesia and Supersensitivity Psychosis Due to Olanzapine Use.

Tardive dyskinesia (TD) usually appears after years of antipsychotic drug use and appears to be related to the total lifetime medication dose. In withdrawal-emergent dyskinesia (WE-D), which is considered to be a subtype of TD, dyskinetic symptoms often appear shortly after a rapid reduction in antipsychotic drug dose or sudden discontinuation of the drug. Supersensitivity psychosis, which is frequently observed along with TD and is considered to have a similar etiology as TD, is a psychotic relapse phenomenon that occurs after the withdrawal of an antipsychotic drug or a rapid reduction in the drug dosage. In general, atypical antipsychotics tend to be associated with less propensity to cause TD when compared with typical antipsychotics. Furthermore, olanzapine and clozapine may have a therapeutic potential in improving or totally curing TD. In this study, a case of WE-D because of discontinuing olanzapine use and supersensitivity psychosis is discussed.

Relationship Between Metabolic Syndrome and Clinical Features, and Its Personal-Social Performance in Patients with Schizophrenia.

The aim of this study was to evaluate the metabolic syndrome (MS) criteria and also to investigate the effects of MS on medical treatment, clinical course and personal and social performance in patients with schizophrenia. One hundred-sixteen patients with schizophrenia were included in the study. Measurements of MS were calculated in all patients. Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia, Personal and Social Performance Scale (PSP) were applied. The frequency of MS according to IDF criteria was 42.2 % among the patients. There was no significant difference between patients with and without MS in terms of age. The ratios of MS were 62.5 % for the group taking typical and atypical antipsychotics together and 35.7 % for the group taking two or more atypical antipsychotics together. The duration of disorder in patients with MS was higher than those without MS. Furthermore there was no significant difference between the schizophrenic patients with and without MS, in terms of PSP scores. Our findings showed that the duration of illness, high scores of BMI, use of clozapine or concurrent use of typical and atypical antipsychotics, depressive and negative symptoms of schizophrenia were significant risk factors for the development of MS.

Attentional Bias and Training in Social Anxiety Disorder.

Cognitive behavioral therapy (CBT) is one of the most effective treatment modalities for social anxiety disorder (SAD), showing a high level of clinical evidence supporting its effectiveness. On the other hand, lack of the desired benefit from this treatment in some patients causes continuation of the search for new techniques. Recent research studies have focused on attentional bias and attention training in SAD. Attention processes in SAD have been a major target of interest and investigation since the introduction of the first cognitive models explaining SAD. In the first model, it was highlighted that attention was self-focused. The relationship between threatening stimuli and attention was considered in the subsequent models. Attentional bias towards threat may take place in several ways, such as facilitated processing of threat, difficulty in disengaging attention from the threat and avoidance of attention from the threat. After these descriptions regarding the phenomenology of the disorder, treatments to modify attention, processes were developed. In spite of conflicting results, investigations on attentional training are promising. Attention processes, attentional bias and attentional training in SAD are discussed in this review.

Effects of childhood trauma and clinical features on determining quality of life in patients with bipolar I disorder.

BACKGROUND: We explored how childhood trauma (CHT) affects the clinical expression of disorder and quality of life in patients with bipolar I (BP-I) disorder. METHODS: Euthymic patients (n=116) who subsequently received a diagnosis of BP-I disorder were consecutively included and were interviewed using the following sociodemographic and clinical data forms; Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Abuse and Neglect Questionnaire (CANQ) and the 36-item Medical Outcome Study Short Form Health Survey (SF-36). The quality of life of BP-I patients with and without a history of CHT were examined. RESULTS: The percentage of trauma was 61.2%. Patients who had CHT had higher frequencies of depressive episodes (t=-2.38, p=0.019), total episodes (t=-2.25, p=0.026), attempted suicide more often (χ(2)=18.12, p=0.003) and had lower scores on the pain subscale of the SF-36 (z=-2.817, p=0.005). In patients with mixed or rapid-cycling episodes, SF-36 subscale scores except general health and pain were found to be lower. LIMITATIONS: Our sample may fail to reflect the general BD population; the patients were included consecutively and consisted of a majority of female patients. CONCLUSIONS: CHT plays an important role in the clinical expression of BP-I disorder and having mixed/rapid-cycling episodes negatively affects both physical and mental components, as measured by the SF-36. While both males and females reported experiencing sexual abuse, female BP-I patients complained about pain more often. It is suggested that treatment of BP-I patients with a history of CHT should differ from that provided for patients with no CHT history.

Thyroid status in lithium-treated bipolar disorder patients: An one-year follow-up study / Estudio de un año de seguimiento del estado de la tiroides en pacientes con trastorno bipolar tratados con litio

Objective In this follow-up study, the hormonal changes were determined in bipolar euthyroid patients who were treated with lithium for the duration of one year. Method For the study, 23 bipolar I disorder patients without any axis I co-morbidity were consecutively selected and followed up for one year. All patients were compared with 25 age- and sex-matched healthy controls in terms of thyroid hormone levels and thyroid volumes. The Sociodemographic and Clinical Characteristics Data Form, Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I and SCID-I/NP) were administered. Initial thyroid hormone levels and thyroid volumes were measured in the patients and controls. Patient and control groups were compared at baseline for thyroid volumes. Patients' lithium levels were measured at baseline, they were re-examined at six months for thyroid hormones, and at the first year for thyroid hormones and lithium levels. Results Thyroid hormone levels changed in no patients during the follow-up period. Thyroid hormone levels were measured within the normal range. No correlation was found between the final TSH levels and duration of illness, duration of lithium treatment, initial thyroid volumes, and the initial TSH levels. Conclusions Lithium can safely be used in bipolar patients who were already receiving this treatment before and not developed any thyroid problem for a substantial period.

En este estudio de seguimiento se determinarán los cambios hormonales que se producen en pacientes eutiroideos con trastorno bipolar en tratamiento con litio durante un periodo de un año. Método Para el estudio se seleccionaron de forma consecutiva 23 pacientes con trastorno bipolar tipo I sin prevalencia concomitante de otros trastornos del eje I, y fueron seguidos durante un año. En todos los pacientes se compararon los niveles de las hormonas tiroideas y el volumen de la glándula tiroides con las del grupo control sano pareado por sexo y compuesto de sujetos de 25 años de edad. La evaluación se hizo por medio de: una hoja de datos de las características sociodemográficas y clínicas, la Escala de Valoración de Hamilton para la Evaluación de la Depresión (HDRS), la Escala de Young para la Evaluación de la Manía (YMRS), Entrevistas clínicas estructuradas para los trastornos del eje I del DSM-IV (SCID-I y SCID-I/NP). A los pacientes y al grupo control se les midieron los niveles iniciales de las hormonas tiroideas y el volumen de la glándula tiroides, a la vez que se les comparó la línea base del volumen de la glándula tiroides. Al inicio del estudio se determinó la línea base de los niveles de litio en los pacientes. Al sexto mes, se reexaminaron las hormonas tiroideas y, al cabo del primer año, los niveles hormonales tiroideos y de litio. Resultados Los niveles de las hormonas tiroideas no sufrieron cambios en ningún paciente durante todo el seguimiento. Dichos niveles se midieron dentro de los intervalos normales. No se detectó ninguna correlación entre los niveles de TSH y la duración de la enfermedad, ni con la duración del tratamiento con litio, ni entre los volúmenes iniciales de las glándulas tiroideas con los niveles iniciales de TSH. Conclusión El litio puede administrarse con seguridad en pacientes bipolares que se hayan sometido antes a este tratamiento, y a los cuales no les produzca problemas tiroideos durante un periodo significativo de tiempo.

Differences in Affective Temperaments in Anxiety Disorders: Comparison of Panic Disorder and Obsessive Compulsive Disorder.

INTRODUCTION: In this study, probable differences in affective temperament among anxiety disorders were investigated via a comparison of panic disorder (PD) and obsessive-compulsive disorder (OCD). METHOD: 44 patients with OCD and 42 patients with PD, who were admitted to Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery outpatient clinics with complaints of OCD and PD and were diagnosed according to DSM IV criteria, were consecutively included in the study after informed consent was taken. A sociodemographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory, Panic and Agoraphobia Scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were given to the patients. PD and OCD patients were compared in terms of affective temperament characteristics. RESULTS: Mean age, educational status and gender distribution of OCD and PD patients were similar (p>0.05). Dominant depressive temperament was more prominent in OCD group than in PD group (p=0.021). Hyperthymic temperament scores were higher in PD group than in OCD group (p=0.002). Dominant hyperthymic temperament was not encountered in either group. CONCLUSION: Dominant depressive temperament was more prominent in OCD group whereas hyperthymic temperament scores were higher in PD group. These findings should be evaluated in studies with larger sample sizes.

The relationship between temperament and character in conversion disorder and comorbid depression.

AIMS: The aim of this study was to compare conversion disorder patients with healthy controls in terms of temperament and character, and to determine the effect of these characteristics on comorbid depression, based on the idea that conversion disorder patients may have distinctive temperament and character qualities. METHODS: The study involved 58 patients diagnosed with conversion disorder, based on the DSM-IV diagnostic criteria, under observation at the Bakirköy Psychiatric and Neurological Disorders Outpatient Center, Istanbul. The patients were interviewed with a Structured Clinical Interview (SCID-I) and 57 healthy volunteers, matched for age, sex and education level, were interviewed with a Structured Clinical Interview for people without a psychiatric disorder (SCID-I/NP). All the participants completed a sociodemographic form, the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Temperament and Character Inventory. RESULTS: The conversion disorder patients displayed more harm avoidance (P<.001), more impulsivity (P<.01) and more sentimentality (P<.01) than the healthy controls, but were less persistent (P<.05). In terms of character qualities, conversion disorder patients had high self-transcendence (P<.05), but were inadequate in terms of self-directedness (P<.001) and took on less responsibility (P<.05) than the healthy controls. CONCLUSION: Conversion disorder patients are significantly different from healthy controls on temperament and character measures of harm avoidance, persistence, self-transcendence and self-directedness.

Physical deformity associated with psychotic symptoms in two patients with schizophrenia.

Movement disorders and related physical deformities may sometimes be observed in patients with chronic psychotic disorders. In this article, we present the case of two patients with physical deformities associated with chronic psychotic disorders. In the first case, the patient had never sought psychiatric care despite her long-standing psychiatric disorder. The patient, diagnosed with disorganized schizophrenia, developed cervical kyphosis, due to her constant neck flexion posture. The other patient had been undergoing treatment for a long period under the diagnosis of paranoid schizophrenia. In the latter case, peroneal nerve injury and dropped foot had developed due to a constant crossing of the legs. Physical deformity may also develop as a result of physical inactivity-hypokinesia, a fixed body posture, and postural disorders in chronic psychotic patients. Due attention should be given to physical symptoms in this group of patients and physical deformities should be treated alongside the patient's psychotic symptoms.

Antidepressant-associated mania or hypomania: a comparison with personality and bipolarity features of bipolar I disorder.

BACKGROUND: Hypomania/mania during antidepressant treatment is often neglected by clinicians. There are no specific diagnostic criteria for hypomania and mania associated by antidepressant treatment in the bipolar spectrum. The aim of this study is to compare various characteristics of bipolar I disorder and antidepressant-associated mania. METHOD: In this study, 76 bipolar patients who met DSM-IV criteria for bipolar disorder-type I in remission from mania or depression (Group 1; n = 44) and patients with major depression in remission, who had mania associated by antidepressant treatment (Group 2; n = 32), were admitted. All patients were assessed using the SCID I, Bipolarity Index (BI) and a patient data form. First-degree relatives of all patients were evaluated using the Mood Disorder Questionnaire (MDQ). RESULTS: Sociodemographic features of both groups were similar. The rate of major depression in the relatives of Group 2 was significantly higher than in Group 1. The severity of manic symptoms in Group 2 was significantly lower than in Group 1. Those in Group 2 who were diagnosed with their first episode had atypical depressive features. First-degree relatives of patients in Group 1 had higher positive scores on the MDQ. A statistically significant difference was found between the two groups on all dimensions of the BI except family history. LIMITATIONS: This is a cross-sectional study with a relatively small number of subjects. There is no control group of major depressive patients who did not develop mania during antidepressive treatment. CONCLUSIONS: Our results suggest that antidepressant-associated hypomania/mania could be a different subgroup in the bipolar spectrum.

The use of electroconvulsive therapy in pregnancy: a review.

Treating psychiatric disorders during pregnancy poses a challenge. Both medication and maternal illness may have adverse effect on the fetus and balancing the risks and benefits of symptoms and treatments is crucial. Medications may affect the fetus adversely, especially in the first trimester. Electroconvulsive therapy (ECT) is not known to have adverse fetal effects and therefore may be preferred. A review of the literature and our clinical experience highlight the role of ECT during pregnancy, sometimes offering advantages over pharmacotherapy.

Efficacy of high-dose aripiprazole for treatment-resistant schizoaffective disorder: a case report.

Aripiprazole is an atypical neuroleptic with a unique mechanism of action. According to the package insert, the maximum recommended dose for aripiprazole is 30 mg/day. In clinical practice, off-label prescribing of medications, including the use of doses that exceed the manufacturer's recommendations, is not uncommon. Most premarketing studies are designed principally to demonstrate safety, efficacy, and tolerability and often exclude many patients who are treated after a drug has been released.To report a case with treatment-resistant schizoaffective disorder in which a patient tolerated and responded to high-dose aripiprazole; an objective is to discuss the use of aripiprazole dosages at higher than those recommended in the product's labelling.

Electroconvulsive therapy-induced mania: a case report.

INTRODUCTION: Despite its controversial history, electroconvulsive therapy is generally an effective treatment with few serious side effects. One rare but troublesome side effect of electroconvulsive therapy is mania. CASE PRESENTATION: A 33-year-old Turkish woman developed mania on three separate occasions after receiving electroconvulsive therapy for severe depressive episodes. CONCLUSION: Patients who experience electroconvulsive therapy-related mania should be evaluated for alternative treatments when presenting with severe depression.

Aggression among male alcohol-dependent inpatients who smoke cigarettes.

The authors aimed to explore the relation between nicotine dependence and the severity of aggression among Turkish male alcohol-dependent inpatients who smoked cigarettes, as well as the effect of aggression in these groups. Participants were 126 male alcohol-dependent inpatients who were given the Structured Clinical Interview for DSM-IV, Substance Use Disorder Module (A. Corapcioglu, O. Aydemir, & M. Yildiz, 1999; M. B. First, R. L. Spitzer, & J. B. W. Williams, 1997), the Fagerstrom Test for Nicotine Dependence (K. O. Fagerstrom, 1978), and the Overt Aggression Scale (OAS; S. C. Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. Williams, 1986). The authors found differences between male alcohol-dependent inpatients with nicotine dependence (n = 94) and those with nondependence (n = 32) in OAS subtypes. The authors' findings showed that smoking cigarettes-an addiction frequently observed with alcoholism-was positively correlated with aggressive behaviors. The authors suggest that smoking cigarettes may cause aggression or aggression may cause smoking. Observing and evaluating how aggression and smoking cigarettes are associated with alcohol dependence may help relapse prevention and improve effectiveness of treatment interventions in alcoholism.

Depression and anxiety in alcohol dependent inpatients who smoke.

BACKGROUND: Research supports the observation that "smokers drink and drinkers smoke." In this study, we aim to evaluate the relationship between nicotine dependence and the severity of anxiety and depression among alcohol dependent inpatients. METHOD: The study comprised 125 inpatients diagnosed as having alcohol dependence. They were given the SCID-I, AUDIT, Fagerstrom Test for Nicotine Dependence,Hamilton Rating Scale for Depression, and Hamilton Anxiety Rating Scale. RESULTS: Our findings showed that the mean scores of the severity of anxiety and depression were high in alcohol dependent inpatients with nicotine dependence, but there was no significant difference between the nicotine dependent and nondependent groups in the severity of anxiety and depression. CONCLUSION: Comparative studies between alcohol dependent patients who smoke and different smoking or nonsmoking groups with anxiety or depression may provide valuable information. Further studies are needed to examine the correlations between these groups.

Practice of electroconvulsive therapy at the research and training hospital in Turkey.

OBJECTIVE: We sought to obtain an overview of electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, which is the biggest hospital for psychiatry in Turkey. METHOD: From 1st January 2006 to 30th June 2007, a form enquiring about evaluation of ECT was filled retrospectively. RESULTS: The total number of patients, admitted for psychiatry during the survey period was 265,283. A total of 1,531 patients (12.4% among inpatients and 0.58% in all psychiatric admissions) received 13,618 sessions (including multiple hospitalizations) of ECT from 12,341 psychiatric inpatients during the survey period. Ninety-eight patients had multiple hospitalizations. The male-to-female ratio was 1.26-1. Patients with bipolar affective disorder, current episode manic with or without psychotic symptoms received ECT most frequently (30.3%), followed by patients with schizophrenia (29.5%), severe depressive episode with or without psychotic symptoms (include bipolar affective disorder current episode severe depression) (15.2%), other non-organic psychotic disorders (14.4%), schizoaffective disorders (6.3%), mental and behavioral disorders due to psychoactive substance abuse with psychotic disorders (3.5%) and catatonic schizophrenia (0.7%). Patients who received ECT were in age group of 25-44 years (64.7%), followed by 45-64 years (17.7%), 18-24 years (15.4%), 65 years and older (1.4%), and younger than 18 years (0.8%). All patients received modified ECT. There were no ECT-related deaths during the survey. CONCLUSION: The rate of ECT among all psychiatric inpatients during the survey period was 12.4%. The majority of patients who received ECT were diagnosed with bipolar affective disorder-current episode manic and schizophrenia. ECT training programs for psychiatry residents and specialists should be planned, and conducted systematically.

Quality of life, depression and anxiety in alcohol dependence.

INTRODUCTION AND AIMS: Quality of life is recognised increasingly as an important component in the evaluation of disease processes. Comorbid psychiatric diagnoses accompanying alcohol addiction, especially severe cases of anxiety or depression, may have a negative impact on quality of life. This study focused on the impact of severity of anxiety and depression on quality of life of 150 alcohol-dependent patients treated in hospital. DESIGN AND METHODS: Consecutive patients were evaluated using relevant quality of life scales at the study's onset and 3 and 6 weeks after the complete disappearance of withdrawal symptoms. Patients were classified into three groups: patients with alcohol dependence only, patients with depression and patients with anxiety. RESULTS: The level of anxiety and depression decreased from the initial evaluation to week 3 in patients with a high level of anxiety and depression, whereas the level of anxiety increased in the alcohol only-dependent patients. Initial evaluation conducted using the quality of life scales indicated significant differences between the three patient groups: physical health (F = 7.92, p = 0.001); psychological (F = 32.21, p = 0.001); social relationship (F = 3.45, p = 0.03); and environment (F = 7.79, p = 0.001). At weeks 3 and 6, quality of life for physical health, psychological and environment areas differed significantly between patient groups, but social relationships did not. At weeks 3 and 6, quality of life was lowest in patients with depression and highest in alcohol only-dependent patients with a low severity of depression or anxiety. DISCUSSION AND CONCLUSIONS: Symptoms of anxiety and depression accompanying alcohol addiction lead to an increase in severity of the problems associated with the addiction and have a negative effect on quality of life. Measurement of quality of life within the scope of treatment programmes would help to identify treatment requirements in addicted patients.

Electroconvulsive therapy use in pregnancy.

Treatment of psychiatric disorders during pregnancy poses many challenges. Electroconvulsive therapy is a relatively safe and effective treatment during pregnancy if steps are taken to decrease potential risks. In this article, we discuss premature labor in a patient who underwent electroconvulsive therapy.

A psychotic disorder related to use of herbal preparation: case report.

This article deals with the increasing frequency with which herbal preparations are being used in Turkey. The ingredients of herbal preparations are multiple and include a variety of herbal seed and leaf-related components. Thus, it is not possible to pinpoint a specific chemical culprit without careful analysis of each. In this article, we present a case of psychotic manic state due to the herbal preparations.

Alexithymia and anxiety sensitivity in Turkish depressive, anxiety and somatoform disorder outpatients *.

Objective. To assess the relations between anxiety sensitivity, and dimensions of alexithymia in somatoform, anxiety and depressive disorder patients. Methods. The sample consisted of 124 patients with the diagnosis of depressive, anxiety, or somatoform spectrum disorders (DSM-IV). Toronto Alexithymia Scale (TAS-20), 16-item Anxiety Sensitivity Index (ASI), Hamilton Depression (HDRS), and Anxiety (HAS) scales were used. Results. The total sample (n=124) was divided into three diagnostic categories. There was one Depression Group (n=69). Due to small sample sizes, diagnoses in anxiety and somatoform spectrum disorders were combined in two relatively larger Anxiety (n=42) and Somatoform Groups (n=13) for statistical purposes. No statistically significant difference was found in the TAS-20 total or subscale scores between the three diagnostic groups. In all three diagnostic groups, there was a strong and significant positive correlation between ASI and TAS-20 total scores. In all three groups, there was a significant positive correlation between TAS-20 Factor 1 and ASI. In the Depression and Somatoform Groups, ASI scores were found to be significantly positively correlated with scores on TAS-20 Factor 2. Conclusion. This study reveals that alexithymia does not differentiate depressive, anxiety, or somatoform disorders, yet suggests a functional relation with anxiety sensitivity on a subscale basis.