Could Weight Loss During Clozapine Therapy be an Indicator of Poor Response?: A Case Report. / Klozapin Tedavisi ile Kilo Kaybi Tedaviye Zayif Yanitin Göstergesi Olabilir mi?: Olgu Sunumu.

Even though effectiveness of clozapine on treatment resistant schizophrenia has been repeatedly demonstrated, it is also associated with many adverse effects including weight gain. Curiously, significant weight loss may occur in some patients. In this case report we discussed whether the observed weight loss could be a negative prognostic factor. The 56 year-old male patient, followed up with the diagnosis of schizophrenia for 20 years, had persistent positive and negative symptoms despite concurrent use of different antiypsychotics. He was diagnosed with treatment-resistant schizophrenia and started on clozapine with dose titration to 500 mg/day over 3 months. He was observed to have lost 17.6% of his initial body weight after 7 months of therapy. The Positive and Negative Syndrome Scale (PANSS) score of the patient did not change significantly. There are a few case reports in the literature on weight loss during clozapine therapy. Some proposed that the weight loss could be a sign of weak response to treatment which is based on the observation that the clinical response might be poor when there is a weight loss and no change in blood triglyceride levels is observed with the treatment. There is a need for more case-control and preclinical studies to explain the mechanisms underlying weight loss and weak response to clozapine therapy in schizophrenia.

Dissociation in bipolar disorder: Relationships between clinical variables and childhood trauma.

OBJECTIVE: The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES). METHOD: This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared. RESULTS: The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item-total correlation r scores: >0.20, Cronbach's alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and depersonalization/derealization (SubDES-2). Although age at onset of BD was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES-2. Of all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or SubDES-2. CONCLUSION: The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration.

[The validity and reliability of the Brief-Hypomanic Attitudes and Positive Predictions Inventory-Turkish version]. / "Hipomanik Tutumlar ve Pozitif Yordamalar Ölçegi" kisa formunun geçerlik ve güvenilirlik çalismas.

OBJECTIVE: There has been a great deal of interest in specific dysfunctional beliefs that may be associated with susceptibility to mania. The Hypomanic Attitudes and Positive Predictions Inventory (HAPPI) was developed by Mansell (2006) to identify such beliefs. The present study aimed to measure the psychometric properties of the Turkish version of the brief version of the HAPPI (Brief-HAPPI-TR). METHOD: The study sample consisted of 115 outpatients with bipolar disorder (BD) and 103 healthy controls. Participants were administered the Brief-HAPPI-TR, Mood Disorder Questionnaire (MDQ), and Dysfunctional Attitudes Scale (DAS). RESULTS: The reverse-scored HAPPI items lowered the alpha coefficient and were therefore excluded from the total score. The remaining items had high internal consistency for the entire sample (r = 0.84), for the BD group (r = 0.83), and for the control group (r = 0.86). The test-retest reliability coefficient was moderately high (r = 0.41). Brief-HAPPI-TR scores were significantly correlated with MDQ and DAS scores. Finally, Brief-HAPPI-TR was able to differentiate between the BD patients and controls. CONCLUSION: Brief-HAPPI-TR was observed to be valid and reliable for assessing hypomanic attitudes in Turkish BD patients in remission. In addition, we think that within the cognitive-behavioral paradigm this scale can be used to identify and treat dysfunctional cognitions in Turkish BD patients.

Comparison of Sexual Function and Hormonal Parameters Between Mood Stabilizer Treatment Modalities in Bipolar Disorder.

INTRODUCTION: The aim of this study was to determine the differences between lithium and atypical antipsychotics (quetiapine and olanzapine) with regard to their effects on sexual functions and hormonal variables and to assess the findings in term of gender differences, in patients with bipolar disorder. METHOD: 28 female and 29 male patients diagnosed as having bipolar disorder type I according to the DSM-IV, using lithium or quetiapine and quetiapine+lithium or olanzapine and olanzapine+lithium were evaluated consecutively. Being in remission period and given informed consent were set as inclusion criteria in these cases. Interviews with the patients were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and SKIP-TURK. Sexual functions and satisfaction were evaluated with the Arizona Sexual Experiences Scale (ASEX) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Blood samples of the patients were taken in order to determine prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and free testosterone (T) levels. RESULTS: GRISS scores in male patients were higher than in female patients (p=.001). The number of manic, depressive and total episodes, and functionality levels were similar between the treatment groups, both in female and male patients. No differences were found between treatment modalities in terms of hormone levels both in female and male patients. Among females, ASEX scores of the patients treated with lithium monotherapy were less than the ones treated with quetiapine and olanzapine. Among patients with quetiapine monotherapy, GRISS scores in male patients were higher than in female patients. CONCLUSION: There are some evidences showing gender-based differences in the side effects of atypical antipsychotic drugs. Future studies with a specific focus on this topic are needed in order to have a better understanding of the basic mechanisms of gender differences.

Stupor due to possible interaction between Lorazepam and valproic acid: report of two cases.

Valproate (VPA) and lorazepam are excreted mainly by glucuronide conjugation. VPA reduces the excretion of lorazepam as a result of the administration of these two medications together. As a result of these interactions, even if rarely, serious adverse effects such as coma may develop. Herein, we present two cases of stupor which developed after the addition of lorazepam to treatment administered with VPA. The first patient was being followed for five years with a diagnosis of schizoaffective disorder. She was subjected to a treatment of VPA at 1000 mg/day and an antipsychotic drug. On the twentieth day of the treatment, Lorazepam 2.5 mg was administered as an anxiolytic. The second patient was being followed with a diagnosis of schizophrenia for nine years. A VPA treatment of 750 mg/day was initiated together with an antipsychotic treatment. On the eighth day of the treatment, Lorazepam 2.5 mg was administered. A few hours later, a stupor manifestation developed in both of the patients. Administration of the entire medication to the patients was terminated and parenteral liquid administration was initiated. The clinical profile was back to normal approximately 24-36 hours following the termination of the medication. Studies about the clinical reflections of the VPA and Lorazepam interaction are limited. However, it must be remembered that as a result of the interaction of these two medications, conditions that vary between stupor and coma may arise.

Low plasma adiponectin levels in panic disorder.

BACKGROUND: The present study was performed to evaluate plasma adiponectin levels in the patients with PD. METHOD: The study group included a total of 28 patients (17 females, 11 males) and 23 age- and sex-matched healthy comparison subjects (10 females and 13 males). The plasma fasting glucose, total cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), and hemoglobin were measured. RESULTS: There were no differences in regard to plasma fasting glucose, total cholesterol, triglyceride, LDL, HDL, and hemoglobin levels between groups. However, the mean adiponectin levels were significantly lower in the patient group (26.96 ± 9.92 ng/ml) compared to controls (37.63 ± 23.17 ng/ml) (t=-2.21; p=0.032). As for the ANCOVA analyses, it revealed the main effect of diagnosis on adiponectin levels (F=5.78, p=0.020) after BMI (body mass index) and gender as covariates. CONCLUSIONS: Consequently, the findings of our study suggest that there may be an interaction between panic disorder and plasma adiponectin. Moreover, they led us to consider that these patients should be also followed as cardiac problems.

Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction.

AIM: Risky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls. METHODS: The study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bakirkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls. MAIN OUTCOME MEASURES: The chi-squared test was used for comparisons between groups and categorical variables. One-way analysis of variance (post-hoc Bonferroni test) was used for demographic data. A 22-item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23-item form for collecting data on risky sexually behavior were administered to the participants. RESULTS: In all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients. CONCLUSIONS: The provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs.

Sexual problems in a sample of the Turkish psychiatric population.

INTRODUCTION: Sexual functioning has received little attention as an important aspect of patient care for those who have severe mental disorders. AIM: The aim of this study is to compare sexual difficulties seen in Turkish psychiatric patients and healthy control subjects. METHODS: Study group consisted of outpatients in remission with schizophrenia (n = 84), bipolar affective disorders (n = 90), heroin addiction (n = 88), and healthy control group (n = 98). A sociodemographical data form and the Golombok Rust Inventory of Sexual Satisfaction were applied to all groups (N = 360). RESULTS: Half of the patient groups and 72.8% of control subjects reported that they had regular sexual life. The patients with heroin addiction complained about more problems in their sexual life than in the other groups. Controls (86.2%) felt more satisfied with their sexual life. Female patients with heroin addiction had statistically significant higher scores in nonsensuality subscale of Golombok Rust Inventory of Sexual Satisfaction. Female patients with schizophrenia and bipolar disorder had statistically significant higher scores in vaginismus subscale than in control group. Between the groups, male patients with bipolar disorder had higher score in most of the items except noncommunication and erectile dysfunction and also had higher total score than in the controls. More men (especially with heroin addiction) thought that their illness and drugs were responsible for their sexual problems, knew the effect of the illness and drugs on their sexual life, and asked questions to their psychiatrists about the problems more than women. CONCLUSION: Patients with bipolar disorders and schizophrenia were unaware of effects of their medication on their sexual life. Finally, it was also found that clinicians in our country do not pay sufficient attention to the sexual problems of psychiatric patients.