The Burden of Urinary Incontinence on Caregivers and Evaluation of Its Impact on Their Emotional Status.

Objective: This study aimed to evaluate caregivers of children with urinary incontinence in terms of the caregiving burden and its associated manifestations. Methods: Caregivers of children who are being treated for urinary incontinence secondary to neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD) were evaluated for caregiver burden (Zarit score), depression (Beck Depression Inventory [BDI]), and anxiety (Beck Anxiety Inventory [BAI]). Additionally, children were evaluated for dysfunctional voiding score. All scores were statistically analyzed for correlation with and relation to the caregiver's emotional status. Results: Zarit score was equal in caregivers of children with neurogenic and non-neurogenic LUTD. BDI score was higher in caregivers of patients with neurogenic LUTD, whereas BAI score was higher in caregivers of patients with non-neurogenic LUTD. In the evaluation performed, considering the etiological difference, Zarit score in the group with non-neurogenic LUTD correlated positively with BAI and BDI scores. In the neurogenic bladder group, Zarit score correlated with BDI score. Conclusion: It is important not only in psychiatric patients, but also in those with other chronic disease processes, to evaluate the mental status of caregivers and to support them in dealing with the problem.

Can BDNF and IL-2 be indicators for the diagnosis in schizophrenic patients with depressive symptoms?

OBJECTIVE: The aim of the current study is to determine whether serum levels of brain-derived neurotrophic factor (BDNF) and interleukin-2 (IL-2) can be biological indicators for the diagnosis of schizophrenia in patients with depressive symptoms. METHOD: Forty-seven patients (11 patients diagnosed with schizophrenia, 16 patients diagnosed with schizophrenia and comorbid depression and 20 patients diagnosed with major depressive disorder) and 20 healthy subjects were enrolled. The Positive and Negative Symptoms Scale, the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale were used for assessment. The serum BDNF and IL-2 levels of all the subjects were studied. RESULTS: Decreased levels of serum BDNF and increased levels of serum IL-2 were found in the patients diagnosed with either schizophrenia, schizophrenia with depression, or major depressive disorder (p = 0.049, p = 0.010; p = 0.001 and p = 0.044; p = 0.027, p = 0.003; respectively) compared with control group. There were no significant differences between the patient groups in their serum BDNF and IL-2 levels. CONCLUSIONS: The present study suggests that neurotrophic factors and immune system changes are involved in the pathogenesis of schizophrenia with or without depressive symptomatology. However, the data do not clarify whether depressive symptoms in schizophrenia occur as a dimension of schizophrenia or as symptoms of major depression that is comorbid with schizophrenia.

[The relationship between the duration of drug use and the bipolar disorder patients' sociodemographic and clinical characteristics]. / Bipolar bozukluk hastalarinin ilaç kullanim sürelerinin sosyodemografik ve hastalik özellikleri ile iliskisi.

OBJECTIVE: The purpose of this study was to determine the duration of psychotropic drug use in the long-term follow-up of bipolar disorder (BD) patients. In addition, this study aimed to investigate their role in the daily clinical practice in association with patient sociodemographic and clinical characteristics. The overarching goal for this study was to produce results that enlighten the development of new treatment strategies. METHOD: Follow-up data acquired from the Psychiatry Department of Uludag University Faculty of Medicine was used to retrospectively evaluate 151 patients diagnosed with BD. Socio-demographic data of the patients and information regarding the disease and the drugs used were analyzed. RESULTS: Of the patients studied, 57.0% were female with a mean age of 41.5±12.8. The mean duration of follow-up was 1985.3±1933 [median 1291 (15-9135)] days; euthymic period accounted for 86.0% of this duration. Interestingly, incompliance with the treatment triggered the switch to mania and ineffective treatment triggered the switch to depression. Medication distribution was as follows: 95.4% of the patients received antipsychotic and mood stabilizer treatments, 3.3% received only mood stabilizer treatment, and 1.30% received only antipsychotic treatment. The major findings of this study was that many sociodemographic as well as clinical manifestations including, early onset (aged ≤18 years), unmarried, first episode of mania, those with disease not showing seasonal features, psychotic symptoms, history of hospitalization, and higher number of manic or hypomanic episodes resulted in increased patient prescribed antipsychotic drugs CONCLUSION: Our data suggests that antipsychotic drugs are being used more frequently and for longer durations in the treatment of BD.

Increased plasma agmatine levels in patients with schizophrenia.

Agmatine is an endogenous substance, synthesized from l-arginine, and it is proposed to be a new neurotransmitter. Preclinical studies indicated that agmatine may have an important role in the pathophysiology of schizophrenia. This study was organized to investigate plasma agmatine in patients with schizophrenia and in healthy controls. Eighteen patients with schizophrenia and 19 healthy individuals constituted the subjects. Agmatine levels in the plasma were measured using the HPLC method. The S100B protein level, which is a peripheral biomarker for brain damage, was also measured using the ELISA method. While plasma levels of agmatine in patients with schizophrenia were significantly increased (p < 0.0001) compared to those of healthy individuals (control), there were no significant changes in the levels of S100B protein (p = 0.660). An ROC (receiver operating characteristic) curve analysis revealed that measuring plasma agmatine levels as a clinical diagnostic test would significantly differentiate between patients with schizophrenia and those in the control group (predictive value: 0.969; p < 0.0001). The predictive value of S100B measurements was not statistically significant (p > 0.05). A multiple regression analysis revealed that the age of the patient and the severity of the illness, as indicated by the PANSS score, significantly contributed the plasma agmatine levels in patients with schizophrenia. These results support the hypothesis that an excess agmatine release is important in the development of schizophrenia. The findings also imply that the plasma agmatine level may be a potential biomarker of schizophrenia.

Effects of long-term antidepressant treatment on oxidative status in major depressive disorder: a 24-week follow-up study.

PURPOSE: Major depressive disorder (MDD) is a devastating disease that afflicts large populations and has also been accepted to be an independent risk factor for cardiovascular disease (CVD). Oxidative stress seems to play an essential role in the relationship of MDD and CVD. We aimed to determine the level of oxidative stress in patients with MDD and to investigate the effects of long-term antidepressant (AD) treatment on the oxidative-antioxidative system parameters and CVD risk factors. METHOD: Fifty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MDD and 44 healthy control subjects were included in the study. Control visits of the patients were repeated 6weeks, 12weeks and 24weeks after beginning of the AD treatment. Lipid profiles, oxidation and oxidizability of apolipoprotein B-containing lipoproteins (expressed as apo B-b-MDA and apo B-Δ-MDA, respectively), levels of plasma malondialdehyde (p-MDA), total antioxidative capacity (TAOC), antioxidant molecules and antioxidant enzyme activities including paraoxonase/arylesterase, red blood cell superoxide dismutase (RBC-SOD) and glutathione peroxidase were determined during 24-week of follow-up period. RESULTS: According to the results of the study, p-MDA, apo B-b-MDA and RBC-SOD activity were increased and arylesterase activity was decreased in MDD patients. Body mass index (BMI), vitamin A and total cholesterol levels in MDD patients increased after 24-weeks of AD treatment. RBC-SOD activity, TAOC, p-MDA and apo B-b-MDA levels were decreased; paraoxonase/arylesterase activities and apo B-Δ-MDA were increased at the end of 24th week. CONCLUSION: Oxidative stress, demonstrated in MDD patients, was partly improved during 24weeks of AD treatment. Increase in paraoxonase/arylesterase activities and decrease in p-MDA and apo B-b-MDA levels after 24weeks seem to be beneficial for reduction of CVD risk in MDD patients. However increased BMI and apo B-Δ-MDA levels are negative cardiovascular effects of long-term AD treatment.

Metabolic, endocrinologic and cardiac effects of amisulpride: a 24-week follow-up study.

BACKGROUND: Amisulpride is a second-generation antipsychotic which has been proved to be effective in the control of both positive and negative symptoms of schizophrenia. In this study we aimed to determine metabolic, endocrinologic and cardiac effects of amisulpride commonly used in our clinical practice. METHODS: A total of 18 patients (11 males, 7 females) diagnosed with schizophrenia received amisulpride at the dosage of 800 mg/day and were followed up for 24 weeks. Positive and negative psychotic symptoms, extrapyramidal and sexual side effects, metabolic, endocrinologic and cardiac parameters were evaluated at regular intervals. RESULTS: Significant improvement in both positive and negative symptoms was observed in patients starting from the second week of treatment. Prolactin levels increased significantly both in men and women starting from the measurement on day 4. Prolactin elevation was significantly higher in women than in men. Increase in total cholesterol level became significant at week 24. No other significant difference was observed between weeks 1 and 24 regarding the other parameters. CONCLUSIONS: The clinical data from the present study supports the fact that amisulpride is an effective and safe antipsychotic drug, but elevates prolactin levels in both sexes.

Reversible escitalopram-induced hypothyroidism.

Some drugs can cause alterations in the concentration of thyroid hormones in blood even without clinical signs of dysfunction or pathology of the thyroid gland. Apart from the well-known relationship between depression and hypothalamic-pituitary-thyroid (HPT) axis, and the impact of selective serotonin reuptake inhibitors (SSRIs) on thyroid indices, hypothyroidism is a very rare adverse effect of SSRI treatment. However, the case presented here demonstrates that escitalopram may have the potential to induce hypothyroidism without any significant clinical signs and symptoms. Therefore, the possibility of SSRI-induced asymptomatic hypothyroidism presented here may help clinicians in this regard.

Are there differences between serotonergic, noradrenergic and dual acting antidepressants in the treatment of depressed women?

BACKGROUND: This study aims to investigate if there is a differential outcome of serotonergic and noradrenergic antidepressant treatment and if menopausal status has an impact on antidepressant response in depressed women. METHODS: Data of the 111 depressed women who were included and completed the previous four open-label studies where patients were evaluated six times during a 10-week period, were pooled in the current study. Each of the reboxetine, sertraline and venlafaxine groups consisted of 37 depressed women. Patients were also divided into two subgroups of age, determining the 44 years as the cut-off point representing the menopausal status. RESULTS: No significant difference was observed in the percent change of Hamilton Depression Rating Scale-17 (HDRS) and remission rates among treatment groups. Percent changes in Clinical Global Impression-Severity of Illness scale (CGI-S) and response rates were in favour of venlafaxine group at week 10. Individual HDRS items 2, 3, 4, 5 and 6 demonstrated significant improvement in the sertraline group, whereas HDRS item 7 demonstrated significant improvement in the venlafaxine group. An early reduction in anxiety subscale was observed in the venlafaxine group. Menopausal status had no impact on the outcome measures. CONCLUSIONS: These results suggest that noradrenergic and serotonergic activity do not differ from each other in treating depressed women. However, serotonergic activity appears to be more prominent in some particular symptoms such as feelings of guilt, suicidal ideation and sleep. Also, menopause does not appear to affect antidepressants' benefit in depressed women.

Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression.

OBJECTIVE: The aim of this study was to assess the validity and reliability of the 30-item Geriatric Depression Scale (GDS) as a screening tool for minor depression in poststroke patients. METHOD: Literate patients older than 18 years of age, diagnosed to have stroke, were eligible for the study. Standardized Mini Mental Status Examination (S-MMSE) and GDS were applied to all patients. The GDS was readministered 7 days later for retest reliability. RESULTS: A total of 85 participants--49 nondepressed and 36 with minor depression--were eligible for the study. Cronbach's alpha coefficient was .89 in internal consistency analysis. The GDS scores were significantly higher (p < .001) in the depressed participants reflecting a high discriminant validity. The highest sum of sensitivity and specificity values of 1.44 (sensitivity = .69, specificity = .75) and 1.45 (sensitivity = .66, specificity = .79) were obtained for cutoff scores of 10/11 and 11/12, respectively. The area under receiver operating characteristics curve was .82. The test-retest reliability analysis revealed a high Pearson correlation coefficient (r = .75). CONCLUSION: Our findings suggest that the 30-item GDS has high discriminant validity, internal consistency, and test-retest reliability and reasonably useful cutoff scores; thus it can be used as a screening tool for minor depression in the poststroke population.

[Reliability and validity of the Turkish version of the Social Adaptation Self-Evaluation Scale (SASS)]. / Sosyal Uyum Kendini Degerlendirme Olçegi (SUKDO) Türkçe formunum geçerlik ve güvenilirligi.

OBJECTIVE: SASS is a new self-evaluation scale that assesses the level of social functioning in depressed patients for clinical research purposes. The aim of this study was to investigate the validity and reliability of the Turkish version of SASS. METHOD: Data were obtained from 2 different sample groups that had no physical disturbances that could impair social functioning; healthy participants between the ages of 18 and 65 years (n = 66) and patients (n = 227) diagnosed with major depressive disorder (MDD). Assessment tools used in the study were SASS, Hamilton Depression Rating Scale, 17-item version, and Global Assessment of Functioning Scale. RESULTS: In the reliability analysis of both groups combined and the MDD group Cronbach's alpha values for the internal consistency of the scale were 0.90 and 0.87, respectively. Item-total score correlations were between 0.22 and 0.66 for both groups combined, and between 0.21 and 0.59 for the MDD group. The correlation coefficient of the scale's test-retest reliability was 0.770 (P < 0.0001) and the SASS value rose from 29.4 +/- 8.1 to 37.8 +/- 8.1 following treatment of depression (P < 0.0001). Four factors with Eigen values > 1 were obtained from the factor analysis. Factor 1, with an Eigen value of 7.169 explained 35.8% of the total variance and represented the entire scale alone. CONCLUSIONS: The Turkish version of SASS, as the original scale, demonstrated adequate validity and reliability for the measurement of loss of social functioning in MDD patients and demonstrated that scores changed in accordance with treatment for depression.

Effects of various antidepressants on serum thyroid hormone levels in patients with major depressive disorder.

A total of 62 patients with major depressive disorder were analyzed in the study. Patients were evaluated for 11 weeks in an open label design to investigate the differential effects of reboxetine, sertraline and venlafaxine on thyroid hormones. Serum thyrotrophin (TSH), thyroxine (T4) and free (f)T4 levels were measured before and after treatment. All groups showed significant improvement in HAM-D scores. TSH level significantly reduced and T4 level significantly increased in the reboxetine group, however TSH level significantly increased and T4 level significantly reduced in the sertraline group. Percent changes of TSH (p=0.007) and T4 (p=0.001) were significantly different between the reboxetine and sertraline groups. In the sertraline group, baseline TSH levels were correlated with response to treatment as determined by the change in HAM-D scores (p=0.03, r=0.648). There was a significant association between the percent changes in TSH values and the reduction in HAM-D scores in the reboxetine group (p=0.03, r=-0.434). In the whole study group, female patients had lower values of basal T4 compared with men (p=0.043), however percent changes of T4 did not differ between genders. In the treatment-responders significant increase in the reboxetine group and significant decrease in the sertraline group regarding the T4 values were found. We observed that various antidepressants had different effects on thyroid hormone levels and this could be attributed to the different mechanisms of actions of these antidepressants.

Retrospective database analysis on the effectiveness of typical and atypical antipsychotic drugs in an outpatient clinic setting.

OBJECTIVE: To report the outcomes of a retrospective database analysis to compare the effectiveness of atypical and typical antipsychotic drugs. METHODS: Medical records of patients admitted to the psychiatry outpatient clinic between January 1998 and October 2005 were retrospectively reviewed. Data obtained from patient records were noted on a special form assessing four aspects of the treatment history: socio-demographic features, disease characteristics, initial treatment at the time of admission, and course of treatment. Patient groups (typical/atypical and Risperidone/Haloperidol/Olanzapine) were compared for time to all-cause medication discontinuation and rate of discontinuation. RESULTS: There was no statistically significant difference in the duration of treatment between patients using atypical (n = 150) and typical (n = 124) antipsychotics. The duration of treatment was significantly longer in patients on Haloperidol (n = 91) compared with those on Risperidone (n = 63). Rates of discontinuation over 18 months were 59.3% for patients on atypical antipsychotics and 57.3% for those on typical antipsychotics, and 68.3% for patients on Risperidone, 51.6% for patients on Haloperidol and 54.3% for patients on Olanzapine. CONCLUSION: Despite our hypothesis patients with chronic schizophrenia discontinued their atypical and typical antipsychotics, at a high rate with no significant difference indicating substantial limitations in the effectiveness of these drugs.

Coronary artery disease risk factors in patients with schizophrenia: effects of short term antipsychotic treatment.

The aim of the present study was to investigate serum paraoxonase/arylesterase activities and oxidation/oxidizability of apolipoprotein B-containing lipoproteins and several coronary artery disease risk factors, including homocysteine, high sensitive C-reactive protein, tumour necrosis factor-alpha, leptin and adiponectin in patients with schizophrenia. Oxidation of lipoproteins plays an important role in atherogenesis, and the enzyme paraoxonase has been shown to prevent lipoprotein oxidation. Furthermore, low paraoxonase activity has been suggested to predict coronary artery disease. Forty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for schizophrenia and 35 healthy control subjects were included in the study. Serum paraoxonase/arylesterase activities were determined spectrophotometrically. Malondialdehyde levels of apolipoprotein B-containing lipoproteins were determined before and after incubation with copper-sulphate, which yielded basal- and Delta-malondialdehyde values, respectively. Homocysteine and highly sensitive C-reactive protein levels were determined using a fluorescence-polarization immunoassay and immunonephelometry, respectively. Leptin and adiponectin levels were measured with radioimmunoassay and tumour necrosis factor-alpha was determined by enzyme linked immunosorbent assay. Serum paraoxonase and arylesterase activities were significantly lower and Delta-malondialdehyde levels were significantly higher in the schizophrenia group compared with the control group. However, there were not any significant differences in other parameters of the study between the study groups. There was a significant increase in body mass index and serum triglyceride and very low density lipoprotein cholesterol levels in the schizophrenic group after 6 weeks of treatment. These parameters were significantly increased in patients treated with atypical antipsychotics but not in patients treated with typic or long acting antipsychotics. The results of the present study suggest that patients with schizophrenia might have increased risk for coronary artery disease related to reduced serum paraoxonase activity and increased oxidizability of apolipoprotein B-containing lipoproteins.

Trends in the annual incidence rates of narcotics felons arrested over the last 30 years in metropolitan Bursa, Turkey.

Illegal substance use is a serious problem all over the world. In order to effectively combat substance abuse it is important that both the particular features of drug users and the culture-specific risk factors that go along with drug abuse be identified. The present study was carried out in Bursa, Turkey, in order to document annual changes in the frequency of felons arrested of narcotics offenses and to establish the socio-demographics of these narcotics felons. Among the 2,230 narcotics felons reviewed, 24.3% had been charged with drug dealing but not consumption (profit-driven felons [PDFs]), 19.0% were narcotics felons charged with both dealing and consumption ([hard core drug users HCDUs]), and 56.7% were narcotics felons charged only with consumption and possession (not so hard core drug users [NHCDUs]). The NHCDUs were younger (< 30 years) than both the HCDUs and PDFs, while most of the PDFs and HCDUs were married. Despite the fact that the male/female ratio of the Bursa population was nearly 1:1 for the past 30 years, 93.0%, 95.0% and 96.0% of the PDFs, HCDUs, and NHCDUs, respectively, were male. It was also found that the most commonly used illicit substance in Bursa over this period of time was cannabis. Over the course of the 30-year period examined, the annual incidence rate of narcotics felons arrested increased from 0.4257 per 10,000 to 1.2389 per 10,000. Determining the socio-demographic characteristics of HCDUs and NHCDUs would be useful in preventing substance use before substance users become addicted.

Oxidative-antioxidative systems and their relation with serum S100 B levels in patients with schizophrenia: effects of short term antipsychotic treatment.

Oxidative stress may be a contributing factor in the etiopathophysiology of schizophrenia, which may be exacerbated by the treatment with antipsychotics with pro-oxidant properties. Increased levels of S100 B are associated with neurodegenerative disorders, including schizophrenia. The aim of the present study was to investigate the role of oxidative cell damage in the pathogenesis of schizophrenia. Forty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for schizophrenia and 35 healthy control subjects were included in the study. Serum S100 B level was determined to investigate brain damage. Plasma malondialdehyde (MDA) levels and susceptibility of red blood cell (RBC) to oxidation were determined to investigate the oxidative status and plasma vitamin E, vitamin C, serum total carotenoid levels and total antioxidant capacity and RBC superoxide dismutase (SOD) and whole blood glutathione peroxidase activities were measured to investigate the antioxidative defence before and after 6 weeks of antipsychotic treatment. Plasma MDA and serum S100 B levels and RBC-SOD activity were significantly higher in the schizophrenia group than those of the control group. Treatment did not modify any of the oxidative-antioxidative system parameters or serum S100 B levels. S100 B level was significantly higher in patients with negative symptoms than the patients with positive symptoms and the control subjects. S100 B levels were significantly reduced after 6 weeks of treatment in patients with negative symptoms. The results of the present study might support the oxidative cell injury hypothesis of the schizophrenia. Furthermore, the underlying mechanisms of the subgroups of schizophrenia might be different as suggested by the increased S100 B levels and its decrement after treatment in patients with negative symptoms.

Urticaria and angio-oedema due to ziprasidone.

Antipsychotic medications are commonLy associated with adverse cutaneous reactions (ACRs) in approximately 5% of patients. Angio-oedema accompanying urticaria is one of the most serious ACRs. The 36-year-old female patient who was diagnosed with ;Paranoid schizophrenia' 6 years ago, was commenced on ziprasidone 120 mg/day. On day 30 of the treatment, the patient presented urticarial papules and plaques all over the body and angio-oedema in the face. The patient was diagnosed as ;Urticaria + Angio-oedema'. The development of ACRs after the initation of ziprasidone monotherapy, disappearance of lesions after the discontinuation of this antipsychotic, and positive intradermal skin test all suggests a possible causal relationship between ACRs and ziprasidone. To our knowledge, this is the first reported case of urticaria and angio-oedema due to ziprasidone monotherapy. Ziprasidone is a valid and effective choice amongst antipsychotic medications, but this case calls for caution regarding ACRs at the time of prescribing.

Major depressive disorder is accompanied with oxidative stress: short-term antidepressant treatment does not alter oxidative-antioxidative systems.

OBJECTIVE: The aim of the present study was to investigate the oxidative-antioxidative systems and effects of different antidepressants on these systems in patients with major depressive disorder (MDD). METHOD: Ninety-six patients with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of MDD and 54 healthy controls were included in the study. Plasma malondialdehyde (MDA) levels and susceptibility of red blood cells (RBCs) to oxidation were determined to investigate the oxidative status, plasma vitamin E, vitamin C, serum total carotenoid levels, total antioxidant capacity (TAOC), RBC superoxide dismutase (SOD) and whole blood glutathione peroxidase (GPx) activities were measured to investigate the antioxidative defence before and after 6 weeks of antidepressant treatment. RESULTS: Plasma MDA levels and susceptibility of RBCs to oxidation were significantly higher in the MDD group compared with the control group. RBC SOD activity was significantly increased in patients with MDD, and furthermore there was a significant positive correlation between the severity of the disease and SOD activity. CONCLUSION: MDD is accompanied with oxidative stress; however, oxidative-antioxidative systems do not seem to be affected by 6 weeks of antidepressant treatment.

Reboxetine induced erectile dysfunction and spontaneous ejaculation during defecation and micturition.

This is a case report of reboxetine induced erectile dysfunction, seminal emission and ejaculation during defecation and micturition. A 44 year old male who had been suffering from depression without any sexual dysfunction was put on venlafaxine XR treatment. Due to delayed ejaculation and occasional episodes of absence of ejaculation he was switched to reboxetine. At the second week of treatment he reported erectile dysfunction and premature ejaculation, and seminal emission and ejaculation during defecation and micturition occurred later at 8th week of treatment. After he was switched to sertraline 50 mg/day, his erectile dysfunction, premature and spontaneous ejaculation symptoms subsided in 2 weeks. Although reboxetine is reported to be free of sexual side effects, individual vulnerabilities to such unwanted effects should be considered, and sexual dysfunction should be assessed thoroughly during the treatment.