[Clozapine and Olanzapine Associated Atrial Fibrillation: A Case Report]. / Klozapin ve Olanzapin ile Iliskili Atriyal Fibrilasyon: Olgu Sunumu.

OBJECTIVE: Atrial fibrillation is a serious side effect of antipsychotic drugs, it is very rare but can be fatal. In this case report, a subject who developed an atrial fibrillation after receiving clozapine and olanzapine has been presented. CASE: A 49 year-old female patient with a 10-year history of schizophrenia with no additional disease history was admitted to the hospital with the diagnosis of schizophrenia. Clozapine was started to be given as 12,5 mg/day and then it was gradually increased for the patient. After the development of atrial fibrillation when the clozapine dose was at 100 mg/day (25th day of the treatment), the patient was monitored with daily ECG and no medicine was given in this period. Then, after one week, the clozapine was started to be given as 12.5 mg/day and it was increased to a dose of 100 mg per day. Meanwhile, a single dose of 10 mg of olanzapine velotab was given to the patient with no cardiac problems to prevent agitation and atrial fibrillation developed again after that. Holter ECG was within normal limits. Clozapine treatment was discontinued when the treatment dose was 250 mg/day, because atrial fibrillation developed again. After a drug-free one week, atrial fibrillation did not occur during the following haloperidol, risperidone, quetiapine treatments. CONCLUSION: It is especially very important to monitor the cardiac side-effects in the patients who are using atypical antipsyhotic drugs and ECG monitorization is equally important. More studies are needed to be made towards the research of the antipsychotic arrhythmia relationship.

Prevalence of Intimate Partner Violence and Associated Factors.

INTRODUCTION: The aim of the present cross-sectional study was to investigate the prevalence of intimate partner physical violence among depressive Turkish women, as well as the association of intimate partner physical violence with attachment patterns, childhood traumas, and socio-demographic factors. METHODS: The study included 100 women diagnosed with depressive disorder and 30 healthy women. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV axis I disorders, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Adult Attachment Style Questionnaire (AASQ), and Childhood Trauma Questionnaire (CTQ) were used for clinical assessment. RESULTS: It was found that 64% of the women diagnosed with depression were suffering from intimate partner physical violence. In these women, the severity of depression and anxiety symptoms was higher, suicidal ideation and suicide attempts were more common, and the diagnosis of double depression was more prevalent. These women also achieved higher scores in the avoidant and ambivalent subscales of AASQ and higher total scores and higher scores in the physical abuse subscale of CTQ. The partner's and the woman's experiences of physical violence in their families during their childhood predicted intimate partner physical violence for women suffering from depression. CONCLUSION: The investigation of domestic violence contributes to the treatment of depression and also to the recognition and prevention of domestic violence that has profound effects on successive generations.

Naltrexone treatment of kleptomania: a case report.

Kleptomania is an impulse control disorder characterized by a recurrent failure to resist the impulse to steal worthless objects that are not needed for personal use. Very little is known about the etiology, prevalence and treatment. This disorder usually begins during puberty and lasts until late adulthood. In some patients, it may last throughout the person's life. Patients with kleptomania are likely to suffer from comorbid conditions like mood disorders. The patients usually seek treatment for the comorbid psychiatric complaints, rather than the kleptomaniac behavior itself. The literature lacks sufficient knowledge and controlled studies about the treatment of kleptomania. Regarding the treatment of SSRIs, there are case reports and case series, using mood stabilizers, antipsychotics and opioid antagonists. Cognitive behavioral therapy techniques are also used in the treatment of kleptomania. In this study, a female patient is presented with diminishing kleptomaniac symptoms after naltrexone is added to her cognitive behavioral therapy and fluoxetine treatment. She also suffers from the comorbidities of major depressive disorder and obsessive compulsive disorder.

[The perceived burden of care and its correlates in schizophrenia]. / Sizofrenide Ailenin Yükünü Etkileyen Etmenler.

OBJECTIVE: The present study aimed to investigate the perceived level of burden of care and its correlates in family members of schizophrenia patients. METHOD: The study included 239 schizophrenic patients that were followed-up at the psychiatric outpatient clinics of Izmir Ataturk Education and Research Hospital, and Celal Bayar University Medical School, and 239 of their primary caregivers. Patients were assessed using the Positive and Negative Syndrome Scale (PANNS), Global Assessment of Functioning Scale (GAF), Social Functioning Scale (SFS), Brief Cognitive State Examination (BCE), and UKU Side Effect Rating Scale. Their primary caregivers were assessed using the Perceived Family Burden Scale (PFBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Caregiver PFBS scores ere correlated with male patients, female caregivers, inadequate social support, economic difficulty, the presence of chronic physical disorder in the caregivers, patient violence toward the caregivers, total duration of illness, the number of patient hospitalizations, PANNS total and subscale scores, and SFS, BDI, and BAI scores. Perceived burden of care was predicted by the severity of the patients' positive symptoms, SFS independence/competence and interpersonal functioning subscale scores, and caregivers' anxiety and depression levels. CONCLUSION: In order to decrease the burden of care in schizophrenia we recommend effective management of patient symptoms, enhancement of patient social functioning, interventions that target caregivers with high levels anxiety and depression, and social support provided by healthcare professionals.

Depression and anxiety levels in infertile Turkish women.

OBJECTIVE: To investigate the levels of anxiety-depression in women with infertility and to investigate the relationship between psychologic symptoms, course of treatment and cultural factors. STUDY DESIGN: The study included 107 women with primary infertility in the index group and 63 healthy women in the control group. The Hospital Anxiety Depression Scale was applied to both groups to evaluate psychologic symptoms. The same scale was applied once more after 3 months to the infertility group. RESULTS: There was no significant difference in the level of depression-anxiety between the 2 groups. The severity of psychologic symptoms was greater in those in the infertility group who had attempted nonmedical solutions, who were under pressure from their husbands' families because of their infertility and who reported "bad" relations with their husbands. At the end of the 3 months, the group of patients who achieved pregnancy showed significantly lower levels of anxiety and depression scores than the group of patients who did not. Age, attempts at nonmedical solutions, pressure from the husband's family because of infertility and anxiety level at the start of the study were variables that predicted pregnancy negatively. CONCLUSION: It can be useful to take cultural factors into account in evaluating the mental health of infertile women.

T2 hyperintensities in bipolar patients and their healthy siblings.

BACKGROUND: This study investigates the frequency of hyperintensities, which are common in bipolar disorder, in sufferers' siblings who are free of bipolar disorder and to ascertain whether these lesions reflect any familial characteristics. It offers an assessment of the relationship between these lesions and clinical characteristics. METHODS: The study group consisted of 12 patients with bipolar disorder, their siblings who had no history of mental disorder, and a matched control group. All three groups were assessed using SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) for diagnosis, and MRI (magnetic resonance imaging) for signal hyperintensity. RESULTS: No periventricular white matter lesions were encountered in any groups. It was found that in the patients and siblings, the location was in the right cerebral hemisphere in the deep white matter, whereas it was in the left cerebral hemisphere for the control group. Only in the patient group were lesions detected in subcortical white matter in the right cerebral hemisphere. The lesions were localized in the fronto-parietal area. Considering the brain as a whole, more hyperintensities were detected in the patient group compared to the other two groups. The onset of the disorder with a manic episode was increasing probably in the presence of hyperintensities. CONCLUSIONS: Despite being alike in terms of age, more hyperintensities were detected in the patient group than in the siblings and control groups. Contrary to the control group, however, hyperintensities were localized in the right cerebral hemisphere in both the patients and the siblings groups. Hyperintensities seen in the left cerebral hemisphere yield a nonspecific impression. Siblings who have hyperintensities in the right cerebral hemisphere should be followed up and investigated with regard to bipolar disorder.

Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction.

BACKGROUND: Thyroid dysfunction may impair the quality of life (QoL) and may cause psychological symptoms. The aim of this study is to investigate prospectively the effects of thyroid dysfunction on quality of life, levels of depression/anxiety and the changes in these variables after treatment. METHODS: A total of 160 subjects, consisting of an overt hypothyroidism group (n = 33), a subclinical hypothyroidism group (n = 43), an overt hyperthyroidism group (n = 51), a subclinical hyperthyroidism group (n = 13), and a healthy control group (n = 20) were included in the study. All groups were evaluated with the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Short Form-36 (SF-36), and Brief Disability Questionnaire (BDQ). Health-related quality of life (HRQL) was measured by SF-36. RESULTS: Anxiety and depressive symptoms were more severe in patients with overt hypo- and hyperthyroidism (p <0.001). The QoL was worse in overt or subclinical hyper- and hypothyroidism groups than in the control group [p = 0.013 for physical composite score (PCS); p = 0.002 for mental composite score (MCS)]. Psychological symptoms and QoL were improved in overt and subclinical hypothyroidism and overt hyperthyroidism groups as a result of the treatment. The overt hyper- and hypothyroidism groups showed more improvement than the subclinical groups. CONCLUSIONS: This study suggests that restoration of euthyroidism is accompanied by improvement on QoL and psychological symptoms in all groups except the subclinical hyperthyroidism group. Controlled, randomized studies in larger groups are, however, necessary.

From antepartum to postpartum: a prospective study on the prevalence of peripartum depression in a semiurban Turkish community.

OBJECTIVE: To examine the prevalence of depression in the last trimester of pregnancy and within the first 6 months postpartum, to determine whether there is an association between antepartum and postpartum depression and to investigate the risk factors prospectively in a cohort of Turkish women. STUDY DESIGN: In a prospective, community-based, cohort study, 125 women who expected to give birth during the first 6 months of 2002 (January 1, 2002-June 30, 2002) were included. Depression was measured at 36-38 weeks antepartum and then again at 5-8, 10-14 and 20-26 weeks postpartum using the Edinburgh Postnatal Depression Scale. A questionnaire that was devised to collect data on sociodemographic and clinical information on the women was applied. RESULTS: The prevalence of depression was highest in pregnancy (21.6%) and declined gradually in the follow-up period (respectively, 16.8%, 14.4% and 9.6%). Antepartum depression was a statistically significant risk factor during the 6 months postpartum in each of the 3 assessments. In the logistic model, past history of mental illness, history of mental illness in first-degree relatives and adverse life events were associated with antepartum depression; low income, adverse life events and a poor relationship with the husband were associated with postpartum depression. CONCLUSION: Evaluations made in'the last trimester of pregnancy should be very helpful in diagnosing and preventing depression in women at high risk.

Comparison of fluoxetine and paroxetine in type II diabetes mellitus patients.

BACKGROUND: This study aims to investigate the efficacy of fluoxetine and paroxetine on the levels of depression-anxiety, quality of life, disability, and metabolic control in type II diabetes mellitus (DM) patients. METHODS: The patients were first applied the Hospital Anxiety-Depression Scale (HADS). After a psychiatric interview with patients who had scores above the cut-off point, those who were diagnosed as having a major depressive disorder according to DSM-IV criteria were applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Twenty three patients who scored 16 or above on the HDRS were included in the study and given the Short Form-36 (SF-36), and the Brief Disability Questionnaire (BDQ) and HbA1c levels were measured. Patients were randomized on 20 mg/day fluoxetine or 20 mg/day paroxetine treatment. The patients were evaluated with the same scales at the 2(nd), 4(th), 6(th), and the 12(th) weeks. RESULTS: Both groups showed a statistically significant decrease in HDRS, HARS, and BDQ scores with comparison to the index assessment. At the end of treatment, though not statistically significant, a decrease was observed in HbA1c values of the fluoxetine-administered group. CONCLUSIONS: Fluoxetine and paroxetine effectively reduce the severity of major depressive disorder in type II DM patients. There is need for further and longer-lasting monitoring studies with more patients in order to determine whether there is any difference in terms of their effects on glycemic control.

Effects of tibolone on the quality of life, anxiety-depression levels and cognitive functions in natural menopause: an observational follow-up study.

The effects of tibolone on the quality of life (QoL), depression-anxiety levels and cognitive functions were investigated. Seventeen women received tibolone and 25 women did not receive any medication. At the end of the 6-month follow-up period, the QoL was better in the tibolone group in the area of mental health. Disability, anxiety symptoms, menopausal symptoms were significantly reduced in this group.

[Depression-anxiety and disability in the premenopausal and postmenopausal period]. / Menopoz Oncesi ve Sonrasi Dönemde Depresyon-Anksiyete ve Yetiyitimi.

OBJECTIVE: The aim of the study is to compare levels of depression-anxiety and disability in premenopausal and postmenopausal women. METHOD: The study was carried out with women between 45-55 years of age, living in the service area of a Mother-Child Health and Family Planning Center. Women who did not have a menstruation at least for one year were accepted as postmenopausal. The premenopausal group was consisted of women having menstruation. Hospital Anxiety and Depression Scale (HAD) and Brief Disability Questionnaire (BDQ) were applied to the women. RESULTS: Four hundred and ninety four women were recruited to the study. There were 214 women in the premenopausal period and 280 women in the postmenopausal period. In premenopausal women the level of education was higher and smoking was more prevalent; whereas in postmenopausal women the prevalence rates of being housewife and having continuous drug therapy due to chronic physical diseases were higher. In postmenopausal women, levels of depression and disability were significantly higher. In this group, the predictive factors for having a high HAD score were disability, education having a previous psychiatric disorder having drug therapy due to chronic physical diseases, diabetes mellitus, low level, menopause before the age of 40, not having any counselling for menopause, and not having routine laboratory tests. Having a previous psychiatric disorder and not having any counselling were also predicting disability. None of the variables predicted a high HAD score psychiatric disorder and not having any counselling were also predicting disability and disability in the premenopausal women. CONCLUSION: The postmenopausal period seems to predispose women to depressive symptoms and disability compared to the premenopausal period.

[Comparison of regional cerebral blood flow in deficit and nondeficit schizophrenic patients]. / Eksiklik sendromu olan ve olmayan sizofreni tanili hastalarda bölgesel beyin kan akimlarinin karsilastirilmasi.

OBJECTIVE: Brain imaging techniques are commonly used to define changes in the structure and functions of the brain in schizophrenic patients. The relationships between brain images and the cluster of symptoms provide us with more information about heterogeneous forms of schizophrenia. The aim of this study is to compare the regional blood flow of deficit and nondeficit syndrome schizophrenic patients. METHOD: Forty schizophrenic patients under the age of 65, without physical or neurological illness, mental retardation, a history of substance abuse, or ECT over the previous six months were included in the study. The Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, UKU Side Effect Rating Scale, Hamilton Rating Scale for Depression and The Schedule for the Deficit Syndrome (SDS) were used to evaluate the patients. The regional cerebral blood flow was measured semiquantitatively by SPECT imaging using radiopharmaceutical Tc 99m-HMPAO. RESULTS: There was a significant reduction in the regional blood flow of deficit syndrome patients compared to nondeficit ones in the left frontal cortex (p= 0.002), right frontal cortex (p= 0.006) and right temporal cortex (p= 0.04). CONCLUSION: We suggest that dysfunctions in some neuroanatomic structures are related to deficit syndrome and the concept of deficit syndrome is important for understanding underlying pathophysiologic mechanisms.

[Schizophrenia and the family: difficulties, burdens, emotions, needs]. / Sizofreni ve aile: güçlükler, yükler, duygular, gereksinimler.

Treating patients with schizophrenia mostly in the community causes more problems for the families. Shame, guilt, fear, helplessness, hopelessness, and anger are feelings frequently experienced by families. The main difficulties are financial problems, intra-familial conflicts, negative effects on social life, and the rejecting attitude of the community towards the patients. Negative symptoms are especially burdensome for the families. Families with inadequate social support, with high expressed emotion, and who cannot use effective coping styles have heavier burdens. When the relationship between schizophrenia and family is investigated in a historical context, it is seen that most investigators supporting psychological theory consider the family to be the cause of the disease. These theories, which depend mostly on clinical observations and which have damaged the relationship between the clinicians and the family members, have lost their validity during the last thirty years. Family should be included in the treatment plan. Hospitalization due to the first psychotic episode or further psychotic recurrences is the most convenient period for establishing contact with the families. One should approach the family in a supportive and empathic manner, without putting any blame on them. If maladaptive coping styles are being used, one should help the family to change to adaptive ones. In addition to educative and supportive groups, more specific methods like cognitive-behavioral therapies can be used. Families should be supported in terms of forming non-governmental organizations.