Homocysteine, hopelessness, rumination, affective temperaments, and clinical course in patients with bipolar disorder-1.

PURPOSE: This study aimed to explore the associations between homocysteine, rumination, affective temperaments, clinical features, and hopelessness in bipolar disorder-1 (BD-1). MATERIALS AND METHODS: In total, 57 euthymic patients with BD-1 and 57 healthy controls were included. The Beck Hopelessness Scale (BHS), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Ruminative Responses Scale Short Form (RRS-SF) were administered. Homocysteine, folate, and vitamin B12 levels were measured. RESULTS: The BHS total (p = 0.047), TEMPS-A irritable (p = 0.007), and TEMPS-A cyclothymic (p= 0.001) scores were significantly higher than the control group in the BD-1 group. Hyperhomocysteinemia (HHcy) was found in 33.3% of the patients (n = 19). In the HHcy group, age of onset of disease (p = 0.020) was significantly lower than the non-HHcy group in patients. Previous suicide attempt number was significantly correlated with scores of reflective pondering, brooding, and global rumination in BD-1 (p Ë‚ 0.05). Except for hyperthymic temperament, all types of affective temperaments were correlated with the scores of RRS-SF brooding (p Ë‚ 0.05) in the BD-1 group. The RRS-SF brooding scores significantly correlated with the BHS total scores (r = 0.263, p < 0.05); the TEMPS-A hyperthymic (ß = -0.351, p = 0.001) and TEMPS-A irritable (ß = 0.536, p < 0.001) scores significantly predicted the BHS total scores in the BD-1 group. CONCLUSIONS: The findings may lead clinical efforts and future clinical trials to explore and intervene in related sources and presentations of BD-1's adverse consequences.

Olfactory bulbectomy and raphe nucleus relationship: a new vision for well-known depression model.

Background/aim: The olfactory bulbectomy (OBX) technic is a well-known animal model for depression. According to serotonin hypothesis of depression, one of the possible explanations to this mechanism is the destroying effect of OBX on raphe nuclei which especially include serotonergic neurons. In this study, we aimed to explore histopathological findings in raphe nuclei in OBX rats.Materials and methods: Forty-eight rats (8 control group, 10 sham group, and 30 as the study group) were used. No procedure was applied to the control group. Only frontal burr holes were performed at the level of olfactory bulbs (OBs) on the sham group. Mechanical OBX by compression was applied to 20 rats and the OBs of 10 rats were cauterized. Their OBs, olfactory cortices, raphe nuclei were extracted, tissue specimens were taken than examined by using histopathological methods including hematoxylin and eosin, S-100, and TUNEL staining. Physical dissector method was used to evaluate the number of living and apoptotic neurons in the raphe nuclei.Results: Prominent neuronal loss and morphological changes in the dorsal raphe nuclei were detected in study groups.Conclusion: Raphe nuclei degeneration, related alterations in neurotransmitter system activities and functional brain connectivity might be related to neurobiology of depression.

Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

Family patterns of psychopathology in psychiatric disorders.

OBJECTIVE: Familial loading and crucial outcomes of family history of psychopathology in psychiatric disorders have long been recognized. There has been ample literature providing convincing evidence for the importance of family psychopathology in development of emotional disturbances in children as well as worse outcomes in the course of psychiatric disorders. More often, maternal psychopathology seems to have been an issue of interest rather than paternal psychopathology while effects of second-degree familiality have received almost no attention. In this study, we addressed the relations between affected first- and second-degree relatives of probands and categories of psychiatric disorders. METHOD: Subjects were 350 hospitalized psychiatric inpatients, consecutively admitted to psychiatry clinics in Van, Turkey. Mean age was 34.16 (SD±12) and 51.4% of the sample consisted of male patients. Assessment of psychopathology in psychiatric probands was conducted based on DSM-IV TR. Familial loading of psychiatric disorders amongst first- and second-degree relatives of patients were initially noted primarily relying on patients' retrospective reports, and confirmed by both phone call and following official health records via the Medical Knowledge System. We analyzed the data using latent class analysis approach. RESULTS: We found four patterns of familial psychopathology. Latent homogeneous subsets of patients due to familial characteristics were as paternal kinship psychopathology with schizophrenia, paternal kinship psychopathology with mood disorders, maternal kinship psychopathology and core family psychopathology. CONCLUSION: Family patterns were critical to exerting variation in psychiatric disorders of probands and affected relatives. Probands with a core family pattern of psychopathology exhibited the most colorful clinical presentations in terms of variation in psychopathology. We observed a specificity of intergenerational transmission of psychiatric disorders when family patterns of psychopathology were taken into consideration, even second-degree relatives of psychiatric probands.

Relation of ATPase6 Mutations and Telomere Length in Schizophrenia Patients.

Objective: Schizophrenia is a serious mental disorder. Mutations in mitochondrial genes can change energy metabolism. Telomere is a tandem sequence at the end of chromosomes. Shorter telomere length has been shown in schizophrenia. The aim of this study was to determine the relationship between ATPase6 gene mutations and telomere length in schizophrenia patients. Methods: Blood samples of 34 patients and 34 healthy controls were used. In this study conventional PCR, Sanger sequencing technic and real-time PCR were utilized. Results: Five different mutations (A8860G, A8836, G8697A, C8676T, and A8701G) in the ATPase6 gene were identified in schizophrenia patients. The most seen mutation was A8860G (94%). Telomere length analysis indicated the relation of ATPase6 gene mutations and telomere length variations (p = 0.001). Patients carrying the A8860G mutation had shorter telomere lengths than patients carrying other mutations. Comparing telomere length between schizophrenia patients and healthy controls revealed that the mean telomere length of schizophrenia patients was shorter than healthy controls (p = 0.006). The demographic analysis demonstrated a significant relationship between marital status and telomere length (p = 0.011). Besides that, the duration of the illness is another factor that impacts telomere length (p = 0.044). There is no significant relation between telomere length and other clinical and demographic characteristics including education status, age, gender, etc. Conclusion: In conclusion, telomere length and ATPase6 gene mutations have a significant relation. Studies with larger patient populations and investigation of other mitochondrial gene mutations will make the clearer link between telomere length and mitochondrial mutations.

Evaluation Expression of the Caspase-3 and Caspase-9 Apoptotic Genes in Schizophrenia Patients.

Objective: Apoptosis is programmed cell death that occurs by several pathways. Caspase-3 is induced by active caspase-9 via the intrinsic pathway. The aim of this research was to explore the expression of caspase-3 and caspase-9 in schizophrenia patients and healthy samples. Methods: RNA was isolated from the peripheral blood of 39 schizophrenia patients' and healthy samples. After cDNA synthesis, real time PCR (RT-PCR) was used to analyse caspase-3 and caspase-9 gene expression. The severity of psychopathological symptoms of schizophrenia was evaluated using the Positive and Negative Symptoms Scale for schizophrenia (PANSS) and Clinical Global Impressions (CGI). Results: The expression of caspase-3 and caspase-9 genes was higher in schizophrenia patients than in healthy samples (p = 0.012, p = 0.002, respectively). The increase in caspase-3 gene expression was significant with being male, smoking and with a duration of less than 6 years (p = 0.047, p = 0.049, p = 0.034, respectively). On the other hand, the increase in caspase-9 gene expression was significant in patients who is smoke, have children, and are under 33 years old (p = 0.040, p = 0.043, p = 0.045, respectively). A significant positive correlation was detected between the caspase-3 and caspase-9 gene expression (r = 0.3218, p = 0.049). Conclusion: Our findings indicate that caspase-3 and caspase-9 gene expression may activate cell death mechanisms by intrinsic apoptotic genes. Furthermore, caspase-3 and caspase-9 may play essential roles in different ways in schizophrenia. Hence there is a need to further study the apoptotic mechanism with expanded patient populations.

Depression and Anxiety Symptoms in Patients With Cirrhosis: A Prospective Study Before and After Liver Transplantation.

BACKGROUND: Timely identification of possible psychiatric symptoms and/or disorders, such as depression and anxiety, in liver cirrhosis and liver transplant patients is important. This study aimed to determine whether patients with both liver cirrhosis and liver transplantation have depression and anxiety symptoms and, if so, to determine the relationship of these symptoms with the stage of the liver disease and other conditions. METHODS: Ninety patients with liver cirrhosis and 31 who underwent liver transplantation for liver cirrhosis were included in the study. Patients were divided into 4 groups. Patients with Child-Pugh A cirrhosis were group 1, patients with Child-Pugh B cirrhosis were group 2, patients with Child-Pugh C cirrhosis were group 3, and transplanted patients were group 4. All patient groups answered Beck Depression Inventory and Beck Anxiety Inventory questionnaires. RESULTS: Depression and anxiety scores were similar in patients who underwent liver transplantation and in the Child-Pugh A and Child-Pugh B groups. The lowest depression score was observed in the Child-Pugh A group. This was not statistically different from the patients in the liver transplantation group (3.19 ± 3.487, 7.13 ± 7.822, P > .05). Depression and anxiety scores were statistically higher in the Child-Pugh C group (25.55 ± 8.878, 21.66 ± 11.053, and 25.55 ± 8.878, respectively; P < .001), and depression and anxiety scores increased as the cirrhosis stage increased. CONCLUSIONS: In patients with Child-Pugh C liver cirrhosis, evaluation for symptoms of anxiety and depression is strongly recommended.

Association of menopausal symptoms and menopausal quality of life with premenstrual syndrome.

Background: Premenstrual symptoms at reproductive age resemble menopausal symptoms and have symptomatic commonalities. We hypothesized that women with previous premenstrual syndrome may be more prone to develop menopausal symptoms and aimed to investigate the association of menopausal symptoms and menopausal quality of life with premenstrual symptoms. Methods: The study included 120 postmenopausal women. We evaluated the current menopausal symptoms with menopause rating scale (MRS) and quality of life with menopause-specific quality of life scale (MSQoL), previous premenstrual symptoms with premenstrual syndrome scale (PMSS) retrospectively and compared the associations statistically. Results: According to retrospective PMSS, participants were divided into two groups; with and without premenstrual syndrome (PMS). PMS group included 29 (24.2%) participants and 91 (75.8%) participants were in group without PMS. Sociodemographic characteristics of groups were similar. Somatic and psychological symptoms were higher in MRS of PMS group. Evaluating the MSQoL; psychosocial and physical symptoms were impaired in the PMS group. Vasomotor, urogenital and sexual symptoms were similar in both groups. Conclusion: Premenstrual and menopausal symptoms were related in terms of somatic, and psychosocial symptoms but not in vasomotor, urogenital, and sexual symptoms. It seems that women with previous premenstrual symptoms are more likely to develop menopausal symptoms in some ways. However, a prospective longitudinal study may be needed for more conclusive results.

Adaptation and Validation of the Turkish Version of the Ford Insomnia Response to Stress Test in University Students.

Objective: We adapted the Ford Insomnia Response to Stress Test to Turkish (FIRST-T) and validated it. Methods: We randomly divided 774 Turkish university students into two equal groups for exploratory (EFA) and confirmatory factor analysis (CFA). McDonald's omega and Cronbach's alpha values were utilized for reliability analyses. Item response theory (IRT) approach also used for psychometric properties on the full sample. For discriminant validity, study sample were classified into high and low sleep reactivity groups, and their sociodemographic and sleep data were compared. Results: EFA results suggested a one-factor structure of the FIRST-T, which was confirmed by CFA results. The FIRST-T had solid internal reliability. Item analysis results showed that all the items could distinguish between low and high scorers. This scale showed the same construct (clinical insomnia vs good sleepers) across the sexes in multi-group CFA and differential item functioning results. In the high FIRST-T score group, sleep quality, severity of insomnia, and anxiety scores were higher. In this group, more participants had clinical insomnia according to the Insomnia Severity Index (ISI) and were poor sleepers according to the Pittsburg Sleep Quality Index (PSQI) (p < 0.01). Conclusion: The FIRST-T has robust psychometric properties that assesses sleep reactivity among university students.

Nitric oxide, asymmetric dimethylarginine, symmetric dimethylarginine and L-arginine levels in psychotic exacerbation of schizophrenia and bipolar disorder manic episode.

OBJECTIVES: To examine the changes in nitric oxide (NO), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and L-arginine levels in schizophrenia during acute psychotic exacerbation and in bipolar disorder during mania and to compare those changes to healthy controls. METHODS: Thirty schizophrenia patients with acute psychotic exacerbation and 30 bipolar disorder patients with mania, who attended the Psychiatry Department,  Erenköy Hospital for Mental and Nervous Diseases, Istanbul, Turkey, in 2010. Thirty healthy controls were included. The diagnosis was made using the Structured Clinical Interview for Axis I Disorders (SCID-I) interviews. Patients' demographic data were recorded, and NO, SDMA, L-arginine, and ADMA levels were studied. RESULTS: Nitric oxide levels in schizophrenia patients were significantly lower than the control group. Nitric oxide levels in the bipolar group were lower than the control group but the difference was not statistically significant. The levels of SDMA, ADMA, and L-arginine were found to be significantly higher in schizophrenia and bipolar disorder patients than the control group. The disease duration was slightly negatively correlated with NO levels in bipolar patients. In schizophrenia patients, the disease severity was slightly positively correlated with NO levels. CONCLUSION: Significant changes in NO, SDMA, ADMA, and L-arginine levels in schizophrenia and bipolar disorder patients suggest that NO and inhibitors of NO might be implicated in the neurobiology of schizophrenia and bipolar disorder.

[Two stiff person cases misdiagnosed as conversion disorder]. / Kati insan sendromunda konversiyon bozuklugu yanlis tanisi: iki olgu.

Modern psychiatric diagnostic systems classify neurological symptoms that cannot be explained by a physical disease or another psychiatric disorder as conversion disorder (CD) or dissociative motor disorder. It is a well-known fact that the overall rate of misdiagnosis of conversion symptoms is high. The most common presenting symptoms of misdiagnosed patients are gait and movement disturbances. Stiff-person syndrome (SPS) is a rare progressive autoimmune neurological disorder. The identification of antibodies against glutamic acid decarboxylase (GAD) in association with SPS provided an important contribution to the understanding of the pathophysiology of this syndrome. Patients may present with severe muscle rigidity and sudden contractions. Simultaneous contraction of agonist and antagonist muscles produces gait disturbance. SPS can be exacerbated by emotional stressors, and sudden auditory, visual, and tactile stimuli. Herein we present 2 patients that were referred for psychiatric assessment, because their neurological symptoms initially could not be explained by a neurological disease, and subsequently diagnosed as SPS. The aim of this case report is to draw attention to the psychiatric presentations of SPS and to emphasize the importance of complete psychiatric and neurological examination, including brain imaging and electrophysiological studies, in the differential diagnosis of CD.

Postdural puncture headache: Incidence and predisposing factors in a university hospital.

OBJECTIVES: Postdural puncture headache (PDPH) may occur 12-72 hours after spinal anesthesia. PDPH causes patient discomfort following spinal anesthesia and therefore it presents a challenging situation for anesthetists. METHODS: This prospective randomized study enrolled 613 patients who were 18 years or older and who had been operated under spinal anesthesia. The spinal anesthesia procedure was performed with the patient in a sitting position through the L3-4, L4-5 interspaces, using 25 and 26 gauge (G) quincke and pencil-point spinal needles. The gender, age, body mass index, level of sensory block, mobilization time of the patients and also the experience and physical fatigue condition of the physicians were recorded. In the postoperative period all patients were questioned as to whether they experienced headache. These questions were repeated at postoperative 1st, 24th, 48th and 72nd hours in the hospital and on the 7th day by phone after they were discharged. RESULTS: Compared to older patients, patients between the ages of 25 to 40 (p<0.001) and compared to other operations, C/S patients (p: 0.003) experienced headaches more frequently in the postoperative period. The other two important factors were the experience (p: 0.013) and the physical fatigue of the physician (p: 0.001) on the day of surgery. CONCLUSION: The experience and good physical condition of the physician, TUR or anorectal surgery, a patient over 40 years of age and using pencil-point spinal.

The Relationships between Prenatal Attachment, Basic Personality Traits, Styles of Coping with Stress, Depression, and Anxiety, and Marital Adjustment Among Women in the Third Trimester of Pregnancy.

OBJECTIVE: The importance of prenatal attachment, probably as the initial attachment of a pregnant woman to the fetus and which turn into the maternal-baby attachment after birth, for the well-being of the newborn and mother is well known. The aim of the present study was to explore the possible socio-demographic and clinical factors (personality features, styles used in coping with stress, depression, and situational anxiety levels, and marital adjustment) affecting maternal-fetal attachment. MATERIALS AND METHODS: Eighty women on their third trimesters of pregnancy were included in the study. After examination by a psychiatrist, a detailed socio-demographic form and scales including Prenatal Attachment Inventory, Basic Personality Traits Scale, Coping with Stress Attitudes Inventory, State-Trait Anxiety Inventory-1, Beck Depression Inventory (BDI), and Marital Adjustment Scale were applied. RESULTS: Educational level, marital adjustment, social support, and turning to religion as a coping mechanism with stress were found to be positively correlated with prenatal attachment scores. The duration of marriage and number of giving births and the avoidance/disengagement subscale of Coping with Stress Scale and BDI scores were negatively correlated with prenatal attachment scores. A BDI score of ≥17 (this score suggests moderate and/or severe symptoms of depression) was found to be an independent and a negative variable on prenatal attachment. CONCLUSION: We suggest that the detection of symptoms of depression and other factors that may affect prenatal attachment, may help shed light to the interventions to be performed to improve the quality of maternal-fetal attachment by society and governments.

Gadolinium-Based Contrast Agent Extravasation Mimicking Subarachnoid Hemorrhage After Electroconvulsive Therapy.

BACKGROUND: Electroconvulsive therapy (ECT) is a safe method that has been applied for many years in medical treatment-resistant depression treatment. In this case report, contrast extravasation due to deterioration of the blood-brain barrier after ECT mimicking subarachnoid hemorrhage (SAH) on magnetic resonance imaging (MRI) is discussed. CASE DESCRIPTION: A 70-year-old male patient who underwent ECT presented with sulcal hyperintensities suggesting subarachnoid hemorrhage on fluid-attenuated inversion recovery sequence of MRI obtained after ECT. However, there was no evidence to suggest SAH on nonenhanced brain computed tomography. CONCLUSION: It should be kept in mind that patients may have contrast extravasation due to deterioration of the blood-brain barrier after ECT, and other alternative methods should be used for the diagnosis of SAH in these patients, not MRI.

Visual Hallucinations in an Old Patient after Cataract Surgery and Treatment.

Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in patients without mental disorders, are defined as Charles Bonnet syndrome. Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems. The neurophysiology of the visual hallucinations in Charles Bonnet Syndrome is not clearly known, and they may differ in content and severity over time. In differential diagnoses of Charles Bonnet Syndrome, many aetiologies (drugs, uraemia, exposure to toxic materials, neurodegenerative and psychiatric conditions) need to be ruled out. In the treatment of Charles Bonnet syndrome, first the management of the reason of visual loss should be clarified if possible. If needed, neuroleptics, anticonvulsants, antidepressants, benzodiazepines, cognitive enhancer agents such as cholinesterase inhibitors can be used also. In this case, an 83-year-old female patient experiencing visual hallucinations as burning candles in both eyes' visual field after left eye cataract surgery, treated with 0.5 milligram/day risperidone will be presented.