Interleukin-6 levels and HPA axis activation in breast cancer patients with major depressive disorder.

An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major depression exhibit plasma interleukin-6 abnormalities and dexamethasone suppression test results. Four groups, each consisting of 30 women (1--healthy women, 2--patients with major depression, 3--breast cancer patients without major depression, 4--breast cancer patients with major depression), were compared to each other. Psychiatric evaluations were made by structured clinical interview for DSM-IV. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. A dexamethasone suppression test was applied. Breast cancer patients with major depression had markedly higher plasma levels of interleukin-6 than the other group. All breast cancer patients with depression had abnormal dexamethasone suppression test results. These findings suggest a hypothalamo-pituitary-adrenal axis activation and plasma levels of interleukin-6 and plasma interleukin-6 elevation and plasma levels if interleukin-6 and plasma levels of post cortisol concentrations. Evidence for a casual link or association of major depression with immune and endocrinological activation needs to be investigated further.

Sertraline, escitalopram and tianeptine related abnormal movements but not with bupropion: a case report.

It is not scarce that patients experience various extrapyramidal symptoms (EPS) during antidepressant drug therapy. Thus, choice of an antidepressant drug in case of extrapyramidal side effects, at present, is a dilemma. Escitalopram, which is a recently marketed selective serotonin reuptake inhibitors (SSRI), has no such reputation. There is just one case reported for tianeptine that induced abnormal involuntary movements/extrapyramidal side effects. We would like to present a case that was successfully managed with bupropion which had developed EPS during 2 different SSRI (sertraline and escitalopram) and tianeptine therapy.

The role of interactive training skills courses in medical education at the Ankara University School of Medicine.

BACKGROUND: The Department of Medical Education at Ankara University School of Medicine offered a teaching program for their physician educators. One hundred and fifty professors from different disciplines attended this 5-day training course. DESCRIPTION: Two certified master trainers designed the program, which consisted of the following topics: adult learning principles, creating a positive training climate, interactive training techniques, clinical demonstration, coaching principles, effective use of audiovisual materials, developing and using knowledge and competency-based assessment instruments, and organizing training sessions. Master trainers managed all the courses and guided the other trainers according to the principles of group dynamics. Of the overall participants, 30% attended voluntarily (n = 45) and 70% attended compulsorily (n = 105). EVALUATION: In general, 97.5% to 100% assessed the course as either good or very good, with no difference in assessment between the two groups (p > .05; one-way analysis of variance). Course topics and time arrangements for each training session were rated optimal by 82% of participants, and all of them recommended that "all faculty should attend this course." CONCLUSION: The positive effects of these courses have led the School of Medicine's academic council to agree by consensus to accept the training skills course certificate as a criterion for eligibility to become a trainer at the School of Medicine. They also decided to institute educational reform, including changing the curriculum and using new educational methodology such as interactive techniques and problem-based learning.

How we derived a core curriculum: from institutional to national--Ankara University experience.

As the first phase of a major curricular change in a large medical school the core curriculum had to be determined. The criteria for the inclusion of topics in the core curriculum were defined for both clinical and basic sciences. A large group of faculty members have worked in 11 sub-groups to determine the core knowledge, skills and attitudes for undergraduate medical students. During this work 608 clinical topics have been reviewed. Four-hundred and eighty five of them (79%) have been included in the core curriculum. Clinical and basic science knowledge, skills and attitudes relevant to these topics have been defined and classified. A total of 1610 cognitive, 428 psychomotor skills and 247 attitudes have been named. Thus the core curriculum defined is not just a set of diseases, conditions and symptoms but also includes the details of each and every topic. Starting from this point the medical school has participated actively in defining the national core curriculum, which has also been determined according to the same criteria.