High Mobility Group Box 1 Levels as an Inflammatory Mediator in Bipolar Mania.

Introduction: High mobility group box 1 protein (HMGB1) is a member of the molecular family known as damage-associated molecular patterns, which is implicated to have a role in neuroinflammation processes. In recent years, a growing number of studies have focused on the role of inflammation in Bipolar Disorder (BD). This study aimed to investigate the serum levels of HMGB1 and other inflammatory markers in patients with bipolar manic episodes compared to those in healthy controls (HC). Methods: A single-center, observational, case-control study was conducted. Thirty-five patients with BD in manic episodes and 35 HC were assessed. Young Mania Rating Scale (YMRS) was used to assess the symptom severity of the patient group. While inflammatory markers (such as HMGB1, C-reactive protein (CRP) and white blood cell count) were assessed at the first three and the last day of hospitalization in the patient group, they were evaluated once in HC. Levels of inflammatory markers were compared between (patient-HC) and within groups (before-after treatment). Results: No difference was observed in serum HMGB1 levels of bipolar patients with manic episodes compared to the HC (p>0.05). C-reactive protein levels of manic patients were higher than HC (p<0.001), and the difference persisted even after treatment (p=0.007). In addition, there was a significant positive correlation between CRP levels and antipsychotic drug dosage (r=0.382, p=0.024). Conclusion: There were no differences in HMGB1 levels between bipolar patients with acute manic episode and HC. However, higher CRP levels in bipolar patients support the low-grade inflammation hypothesis in the etiology of BD.

The Relationship of Internet, Social Media, and Related Technology Use with Disease Severity and Functionality in Individuals with Serious Mental Disorders.

Introduction: The purpose of this study was to assess internet, social media, and related technology use in patients with serious mental disorders, and to examine their relationship with disease severity and functionality and gain insight about the thoughts of patients with severe mental disorders on benefits and risks of social media. Methods: The study included 150 patients with bipolar disorder and 150 patients with schizophrenia spectrum disorder (82 with schizophrenia, 56 with psychotic disorders not otherwise specified and 12 with schizoaffective disorder) in remission. Information about demographics, clinical features, the use of social media and related technologies, and opinions on social media use were obtained via a data form prepared by the clinicians. Severity of disease and symptoms were measured using the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Brief Psychiatric Rating Scale and, the Clinic Global Impression Scale. The Functioning Assessment Short Test was used to evaluate psychosocial functioning. Results: Among the patients who participated in the current study, 65.3% (n=196) reported internet use and, 59.7% (n=179) reported social media use. The Functioning Assessment Short Test total scores and the Clinic Global Impression Scale scores were significantly higher in patients who did not use social media than in those who did. The use of social media, mobile phones, smartphones, short message services (SMS), e-mail was significantly higher in patients with bipolar disorder than in patients with schizophrenia spectrum disorder. Conclusion: The use of social media, Internet and mobile devices cannot be underestimated among patients with serious mental disorders.

Personality Traits Interact With Sleep and Biological Rhythm in Patients With Bipolar Disorder.

ABSTRACT: Sleep disturbances and circadian rhythm changes in bipolar disorder (BD) may have behavioral components as well as biological components. This study aimed to examine the relationship between personality traits, sleep and circadian rhythm in BD. A total of 150 participants with BD, and 150 healthy controls completed the Big Five Personality Test-50 (B5PT-50-TR), Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), Functioning Assessment Short Test (FAST), Pittsburgh Sleep Quality Index (PSQI), Young Mania Rating Scale and Beck Depression Inventory. In the BD group, B5PT-50-TR emotional stability and openness subscale scores were significantly lower in comparison with the healthy control group. Agreeableness and emotional stability subscales were covariates for the BRIAN sleep subscale and emotional stability was a covariate for PSQI total score. Emotional instability might be a vulnerability factor for sleep disorders and biological rhythm abnormalities in BD. Improvement in emotional instability may relieve sleep disorders and biological rhythm, thereby leading to better treatment outcomes in BD.

The association between chronotype and sleep quality, and cardiometabolic markers in patients with schizophrenia.

Current data on chronotype and sleep quality and their relationship with clinical characteristics of schizophrenia are insufficient to evaluate whether these variables are associated with cardiometabolic risk. We aimed to identify the interplay between chronotype, sleep quality and metabolic indices that can potentially predict negative cardiometabolic outcomes in schizophrenia patients. One-hundred schizophrenia patients who were under a stable antipsychotic regime were enrolled in the study. Clinical information, anthropometric measurements, as well as recent metabolic parameters including serum lipids, atherogenic, and metabolic indices suggestive of cardiometabolic risk were recorded. High and low sleep quality groups (HSQ and LSQ) were determined via the Pittsburgh Sleep Quality Index and chronotypes were evaluated with the Morningness-Eveningness Questionaire. Patients with eveningness chronotype had poorer sleep quality compared to intermediate or morningness (p = .017) patients. The LSQ group had higher total cholesterol (p = .004) and low-density lipoprotein (LDL) (p = .041) compared to the HSQ group. Mean blood pressure was higher in the eveningness chronotype patients compared to intermediate or morningness patients (p = .015). According to a logistic regression model, total cholesterol, disposition index, and having an eveningness chronotype significantly predicted LSQ in schizophrenia. Eveningness chronotype may lead to impaired cardiometabolic regulation with the mediation of poor sleep quality in schizophrenia patients. Cardiovascular diseases, sleep quality, and sleep patterns can influence each other; thus, this complex relationship in schizophrenia should be considered while configuring both pharmacological and behavioral interventions.

Comparison of the Clinical and Treatment Characteristics of Patients Undergoing Electroconvulsive Therapy for Catatonia Indication in the Context of Gender.

The aim of this study was to compare in the context of gender both clinical diagnosis and disease-related differences and electroconvulsive therapy (ECT)-related differences in data and efficacy in hospitalized patients with catatonic signs and symptoms. Data from 106 patients who received ECT with catatonia indication were retrospectively analyzed. Clinical data of male (n = 58) and female (n = 48) patients were compared. Hospitalization documents and outpatient files, sociodemographic and clinical data form, Clinical Global Improvement scores used by the ECT unit in the follow-up of patients who received ECT were used in the study. It was seen that the mean age of women at the onset of ECT was higher than in men and the presence of prolonged seizures was more common than men. In men, it was found out that the average number of sessions with the onset of clinical response to treatment was higher than the average of women. The distribution of diagnoses by gender showed that the presence of schizophrenia diagnosis in men and of bipolar disorder in women were significantly more frequent compared to the opposite sex. It was found out that there were no significant differences between genders in terms of response rate to ECT. Our study is important for being the first study in the literature investigating the gender differences in ECT used for catatonia. However, gender is not a distinctive factor in the effectiveness of treatment, there are some important differences between male and female patients showing signs and symptoms of catatonia and undergoing ECT.

Changes in serum levels of brain-derived neurotrophic factor with electroconvulsive therapy and pharmacotherapy and its clinical correlates in male schizophrenia patients.

OBJECTIVES: It has been postulated that neurotrophin dysregulation leads to disorganisation in neuronal networks, which results in schizophrenia. The current study sets out to evaluate if the finding of lower brain-derived neurotrophic factor (BDNF) levels in schizophrenia patients could be confirmed in an independent cohort and to investigate if the BDNF levels can be altered with different treatment modalities such as electroconvulsive therapy (ECT) and/or antipsychotic pharmacotherapy (PT). METHODS: A total of 54 male patients with schizophrenia and 35 healthy controls were included in the study. Schizophrenia patients were subdivided into two groups as the ones who underwent ECT + PT and only PT. Clinical and sociodemographic data questionnaire, Positive and Negative Syndrome Scale (PANSS) and blood sample collection for BDNF assessment were applied to all patients (on first and last days of admissions) and healthy participants (on the day of the interview). Then, clinical parameters and blood sample outcomes were statistically analysed. RESULTS: Mean BDNF levels of healthy individuals were significantly higher than mean pre- and post-treatment BDNF levels in both PT only and ECT + PT groups. While serum BDNF levels did not increase after ECT + PT, there was a trend level increase in the PT only group. There was no significant correlation between the changes in serum BDNF levels with total PANSS scores in either group after treatment. CONCLUSIONS: We could confirm previously suggested data of lower serum BDNF levels in schizophrenia patients compared to healthy population but we could not find significant increase in serum BDNF levels with ECT + PT or only PT as some previous studies suggested.

Depression and cognitive distortions in hemodialysis patients with end stage renal disease: A case-control study

Background and objectives: Identifying cognitive distortions is essential for Cognitive Behavioral Therapy (CBT) that plays a key role in the treatment of depression. Depression seen in patients with End-Stage Renal Disease (ESRD) has not been sufficiently diagnosed and treated. This study aimed to examine the cognitive distortions and schemas of patients diagnosed with ESRD.MethodsFifty-six patients undergoing hemodialysis and forty-seven controls were enrolled in the study. A sociodemographic and clinic data form, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety and Depression Scale (HADS), Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ) were applied to all participants.ResultsThe prevalence of the psychiatric disorder in the case group was significantly higher than the prevalence of the psychiatric disorder in the control group. Compared with the control group, the HADS depression subscale was significantly high in the patient group. There was a positive correlation between the duration of hemodialysis and total scores of DAS as well as the “dependency attitudes” factor among the case group. The “helplessness” subscale scores of the ATQ were significantly higher in the case group compared to the control group.ConclusionsThe duration of hemodialysis was related to dependency attitudes of cognitive distortions among patients with ESRD. Studies investigating cognitive modalities are needed to treat depression more successfully in this population. It will contribute to the Cognitive Behaviour Therapy of ESRD patients when these factors are taken into consideration. (AU)

Serum nitric oxide levels are depleted in depressed patients treated with electroconvulsive therapy.

BACKGROUND: Nitric oxide (NO) is an endogenous substance which has several endocrine functions and may act as neurotransmitter in the brain. High levels of NO may provoke nitrosative stress. AIM: It was aimed to examine serum levels of NO in patients with depressive episodes who were treated with electroconvulsive therapy (ECT) in this study. METHODS: The design was a case-control, follow-up study. Patients with depressive episodes (n = 23) and a healthy control group (n = 21) were enrolled. Three serum samples were obtained from the patient group (before ECT, after first and seventh sessions). NO, nitrite, and nitrate levels were examined. STATISTICAL ANALYSIS: Differences between groups were examined with t-test or Mann-Whitney U-test. Longitudinal data were evaluated with Panel Regression Analysis and Kruskal-Wallis Test. RESULTS: Serum levels of NO and nitrite decreased significantly after the seventh session of ECT administration compared to the baseline and first session. Nitrate levels did not differ between the assessments. CONCLUSIONS: Reduction of the serum NO and nitrite levels might be a contributing factor for hypertension during the sessions. These findings are reflect the circulating NO levels. Further studies may dissect NO physiology in the brain in mental disorders and potential external effects.

Can Neutrophil-Lymphocyte Ratio Be a Useful Criterion for Neuroleptic Malignant Syndrome in the Absence of Leukocytosis?

Objective: Neuroleptic malignant syndrome (NMS) is a rare but severe side effect of antipsychotic medication. Neutrophil-lymphocyte ratio (NLR) is a simple marker used to measure systemic inflammation. Method : In this case report we explore the relationship of inflammation in the etiology of NMS. In our case involving NMS, although there was no leukocytosis, the NLR was increased up to systemic infection levels. Conclusion: We hypothesized that systemic inflammation may take a role in developing NMS. If so, NLR could be a new marker of NMS that may be able to provide more sensitive results than leukocyte levels.

[Should C-Reactive Protein and Troponin Be Monitored for Early Diagnosis of Clozapine Induced Myocarditis? An Assessment Within the Framework of Two Cases]. / Klozapinle Iliskili Miyokardit Erken Tanisi için C-Reaktif Protein ve Troponin Takibi Yapilmali mi? Iki Olgu Çerçevesinde Bir Degerlendirme.

Clozapine is an important treatment option in patients with treatmentresistant schizophrenia and bipolar disorder. Clozapine has multiple systemic side effects with myocarditis and cardiomyopathy being considered as serious cardiovascular outcomes. Although the aetiology of myocarditis is still unknown, its frequent occurrence in the early stages of clozapine use suggests that type 1 drug hypersensivity may underlie. Although rare, the cardiovascular side effects can be lifethreatening and must be recognized and treated promptly. The nonspecific clinical presentation of these conditions makes risk evaluation and identification of the affected patients difficult. A consensus has not yet been formed on following up the patients without the suspected clinical cardiac symptoms. In this article we presented two cases of myocarditis associated with clozapine. We aimed to emphasize that C-Reactive Protein and troponin monitoring, in accordance with the current clozapine guidelines, was practical and useful for early detection of myocarditis in asymptomatic patients. We also wanted to draw attention to the factors that may increase the cardiovascular risk such as polypharmacy and concomitant use of lithium and valproate with clozapine.

Relationship between impulsivity, comorbid anxiety and neurocognitive functions in bipolar disorder.

OBJECTIVE: The aim of the study is to examine the relationship between anxiety and impulsivity and to reveal the correlation of these variables with clinical and sociodemographic features. It is also aimed to investigate the relationship between impulsivity and anxiety with neurocognitive functions in bipolar disorder. METHODS: The sample of the study comprises of 71 patients with bipolar disorder type I without any comorbidity (BD), 37 patients with anxiety disorder comorbidity with bipolar disorder type I (BDAD), 52 patients with anxiety disorder (AD) and 50 healthy controls (HC). Participants completed Barratt Impulsivity Scale-11, State-Trait Anxiety Inventory 1-2, Panic Disorder Severity Scale (PDSS), brief version of Fear of Negative Evaluation Scale (FNES), Anxiety Sensitivity Index-3 (ASI-3), Trail-Making Test A-B, Digit Span Test, Stroop Test. RESULTS: PDSS scores, trait anxiety level, hypomanic and mixed episode numbers explain 26% of attention impulsivity. Gender and ASI-3 social dimensions explain 16% of motor impulsivity. Trait anxiety explains non-planning and total impulsivity at 26 and 24%, respectively. When neurocognitive impairment's effect was controlled, it was found AD and BDAD groups had higher impulsivity levels than the BD and HC groups. CONCLUSION: Anxiety disorder comorbidity increases impulsivity in bipolar disorder.KEYPOINTSIn the presence of anxiety disorder spectrum comorbidity, bipolar disorder patients will have increased impulsivity and the clinical course may be more severe.Trait anxiety levels and anxiety sensitivity may be predictive factors for impulsivity.In the presence of anxiety disorder spectrum comorbidity, it should be taken into consideration that these patients may be more impulsive and should be treated with more care in terms of evaluation of the disorder.

Electroconvulsive Therapy and Extracellular Matrix Glycoproteins in Patients with Depressive Episodes.

Background: The brain extracellular matrix (ECM) is composed of glycoproteins deriving from the cell membrane and joining into nets called perineuronal nets (PNNs). The ECM glycoproteins limit neuroplasticity, cell proliferation, and differentiation. Electroconvulsive therapy (ECT) is provided by electrical currents that may alter several cascades and biophysical effects. ECM conformation might be influenced by the effects of ECT. Methods: Patients with depressive disorders (n = 23) and healthy control subjects (n = 21) were enrolled. Serum levels of the ECM glycoproteins versican, brevican, neurocan, phosphocan and tenascin C were measured with enzyme-linked immunosorbent assay. Serum samples were collected from the patients in the patient group at 3 time points: before ECT, 30 min after the first session, and 30 min after the seventh session. Results: There was a significant difference in tenascin C levels (P = .001) between the groups. No other significant difference was observed. Serum levels of the measured ECM glycoproteins and prolidase activity did not differ in the depression group after the administration of ECT. Conclusions: Our results did not support the claim suggesting a possible mechanism for modulation of ECM glycoproteins by ECT. Serum levels may not necessarily reflect conformational changes in the ECM. Further studies are needed to investigate the effects of ECT on ECM glycoproteins. Modulation of the ECM may provide a new window suggesting improvement in treatments.

The validity and Reliability of the Turkish Version of Drug Attitude Inventory-10.

INTRODUCTION: Compliance with drug treatment is an important issue in schizophrenia for which many scales have been devised. Turkish version of the Drug Attitude Inventory is frequently employed due to ease of use and high predictive value, although it is not as accurate as blood level testing.To determine the validity and reliability of the Turkish version of the Drug Attitude Inventory-10. METHODS: Eighty-two schizophrenia patients were included in the study. Subjects were evaluated using Drug Attitude Inventory-10, a Sociodemographic Data Form, Positive and Negative Symptom Scale PANNS, Social Functioning Scale, and Quality of Life Scale for schizophrenia patients. RESULTS: Reliability analysis revealed Cronbach's α coefficient for internal consistency to be 0.798 and item-total item correlation coefficients to be between 0.420 and 0.647. Test-retest correlation coefficient (r) was 0.809. Construct validity analysis revealed a tri-factorial construct which accounts for 62.68% of variance. Good conformity to single factor construct was found with confirmatory factor analysis. CONCLUSION: Turkish version of the Drug Attitude Inventory-10 is valid and reliable for evaluation of schizophrenia patients which makes it suitable for research and clinical settings.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study.

INTRODUCTION: Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis. METHODS: Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups. RESULTS: There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared. CONCLUSION: The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.

Posttraumatic growth and its correlates in primary caregivers of schizophrenic patients.

CONTEXT: The concept of posttraumatic growth (PTG) is important to focus on positive outcomes of a challenging process like caregiving. AIMS: The aim of the present study is to investigate the factors inclusively considered to be related to PTG in primary caregivers of schizophrenic patients. SETTINGS AND DESIGN: This cross-sectional study was conducted with caregivers of patients with schizophrenia between January 2013 and February 2014 at a mental health hospital. MATERIALS AND METHODS: The study was carried out on 109 schizophrenic patients followed up at Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, and 109 family members who are the primary caregivers of the patients. All caregivers were evaluated with Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support, Ways of Coping Inventory, and the Basic Personality Traits Inventory and Religious Orientation Scale. STATISTICAL ANALYSIS: Kruskal-Wallis and Mann-Whitney U-test were used in quantitative analysis of data. Spearman's correlation analysis was used in the determination of correlation between variables. Linear regression analysis was used in the determination of predictors of PTG. RESULTS: Optimistic and problem-focused coping, perceived social support (total and all three - family, friends, significant others - domains), personality traits such as extraversion, conscientiousness, and openness to experience, and religiousness were found to be related with PTG. Religiousness, perceived social support, and openness to experience were independent predictors of PTG. CONCLUSIONS: Interventions to caregivers of schizophrenic patients on the domains of social support and coping strategies may contribute to caring process in a positive change.

Executive function and genetic loading in nonpsychotic relatives of schizophrenia patients.

Executive functions meet the "endophenotype candidate" criteria in neuropsychological measures for schizophrenic patients. To determine which area of executive functioning has the greatest value in differentiating the so called "candidate endophenotype" of schizophrenia through comparing the effect sizes of four commonly used executive function tests. A Wisconsin Card Sorting Test, a Stroop Test, a Trail Making Test and a Verbal Fluency Test were used to evaluate executive function in two study groups: healthy relatives of schizophrenia patients from simplex and multiplex families and a healthy control group. In all four tests, study groups performed poorly in contrast to the control group. In the B time, A error and B error results of the Trail Making Test, the multiplex group performed poorly compared to the simplex group; control group did better than both study groups. Our findings support that the presence of a schizophrenia patient in a family predicts worse performance on executive function tests in a group of healthy relatives of that individual. The results of our study suggest that the Trail Making Test in particular may signify a stronger endophenotypic trait.