Comparative evaluation of craving, sleep quality, sexual function and quality of life in opioid use disorder patients in remission with buprenorphine/naloxone maintenance treatment.

AIM: To compare opioid use disorder (OUD) patients who continue to use opioids and are in remission with buprenorphine-naloxone (B/N) in terms of some parameters and to evaluate the relationship between B/N dose and these parameters. METHOD: We included 141 OUD patients in remission with B/N maintenance treatment for at least 6 months, 141 who still used opioids, and 141 healthy volunteers. Substance Craving Scale (SCS), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), and Short Form 36 (SF-36) were administered. RESULTS: PSQI scores and ASEX scores were higher in those who continued to use opiates than in OUD in remission, and in OUD in remission compared to controls. OUD patients with current opioid use also had lower SF-36 scores compared to both patients in remission and healthy controls. SCS, PSQI, ASEX, and SF-36 scores were similar when the three groups were examined based on the dosage of B/N (below 8, 8-15, and 16 mg/day and above) use in OUD in remission. CONCLUSIONS: Quality of life, craving, sleep and sexual functions improved significantly with B/N; however, these effects are not dependent on B/N dosage.

Evaluation of Executive Functions With Functional Near-Infrared Spectroscopy in Euthymic Bipolar and Borderline Personality Disorders.

Introduction: Bipolar disorder (BD) and borderline personality disorder (BPD) are often indistinguishable, given both the key features of impulsivity and emotional dysregulation. This indicates widespread comorbidity and potential misdiagnosis in both groups. Therefore, this study aimed to differentiate BD and BPD by using alterations of brain hemodynamics under the influence of executive tests. Methods: Twenty patients with the euthymic phase of BD and 20 patients with BPD, and 20 healthy control subjects were included in this study. The prefrontal cortex (PFC) hemodynamic responses were evaluated using functional near-infrared spectroscopy (fNIRS) during the Stroop Test and Wisconsin Card Sorting Test (WCST). Results: Left dorsolateral prefrontal cortex (DLPFC) activation was significantly decreased in BPD during both tests. On the other hand, the BD group showed medial PFC hypoactivation during both tests, and this finding is distinct from BPD (p<0.05). Conclusion: Our results indicate that brain hemodynamics during the executive test can highlight differences between BP and BPD. While medial PFC hypoactivation was more prominent in the BP group, DLPFC hypoactivation was more pronounced in the BPD group.

[Association of serum homocysteine and methionine levels with cognition and functioning in bipolar disorder]. / Bipolar Bozuklukta Serum Homosistein ve Metiyonin Düzeylerinin Bilissel Islevler ve Islevsellikle Iliskisi.

OBJECTIVE: The relationship between homocysteine (HCY) levels and cognitive impairments, particularly executive functions in bipolar disorder (BD), has recently been investigated. However, conflicting results were reported. The aim of the present study is to investigate changes in serum HCY, methionine, vitamine B12 and levels in BD patients are relative to controls and to investigate the relationship between HCY, methionine, vitamin B12, and folate levels and clinical features, cognitive functions and psychosocial functioning in euthymic BD patients and controls. METHODS: Sixty BD type I euthymic patients and twenty controls were assessed with Global Assessment of Functioning and a battery of neuropsychological tests including the Wisconsin card sorting test, the Rey's auditory verbal learning test, the Cancellation test, Trail making test A, Trail making test B, and the Stroop test. HCY, vitamin B12, methionine and folate levels were measured together after collecting blood samples from both patient and controls. RESULTS: Mean serum methionine concentration was different between groups. Low serum methionine was found to be a predictor of BD. However, a statistically significant difference was not detected between groups for mean serum values of HCY, folate, or vitamin B12. HCY levels showed a positive correlation with illness duration, the number of total episodes, and the number of manic episodes. A significant correlation was not found between HCY, methionine, folate, B12 levels with cognitive functions and functioning in the BD group. CONCLUSION: Low serum methionine was found to be a predictor of BD, a condition which can lead to a decrease in SAM synthesis and thus to a variety of complications in methylation reactions. Additional studies are needed to clarify the impact of single carbon metabolism on BD.

Levels of TNF-α, soluble TNF receptors (sTNFR1, sTNFR2), and cognition in bipolar disorder.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-α) may play an important role in bipolar disorder (BD) pathogenesis. There is only one study about a relationship between TNF-α levels and cognitive impairments in BD. The aim of the present study was to see whether TNF-α, soluble P55 TNF receptor (sTNFR1), and soluble P75 TNF receptor (sTNFR2) levels in BD patients are different from controls and to investigate the relationships between the levels of TNF-α, sTNFR1, and sTNFR2 and the cognitive functions in euthymic BD patients and controls. METHODS: We assessed 54 BD type I patients and 18 controls by using a battery of neuropsychological tests. Serum TNF-α levels were measured using a commercially available enzyme-linked immunosorbent assay, whereas serum sTNFR1 and sTNFR2 levels were measured using a commercially enzyme-amplified sensitivity immunoassay kit. RESULTS: We found that levels of sTNFR1 and sTNFR2 in BD patients were different from controls. No difference was detected between the BD group and the control group for levels of TNF-α. TNF-α level was found to have a negative correlation with the delayed recall in RAVLT. CONCLUSIONS: High levels of sTNFR1 and sTNFR2 in euthymic patients showed that it may support that proinflammatory process continues in euthymic period. This is the first study which showed increased sTNFR2 levels in euthymic period, which could be interpreted as a compensatory mechanism and again the first which deals with verbal memory.

Psychosocial correlates of substance use among adolescents in Mersin, Turkey.

The objective of this study was to determine the effects of psychosocial factors such as peer group, family and academic self-perception on smoking, alcohol and substance use by adolescents living in Mersin, Turkey. The study included a total of 3282 students from the sixth and tenth grades and college. The number of participating students required from each school was obtained through stratification, and by weighing the enrolled student population in each subgroup. The final sample was derived using a simple random sampling technique. A 45-item self-administered questionnaire was used. The questionnaire included questions about socio-demographic characteristics and lifetime and current (i.e. within the past month) use of cigarettes, alcohol, cannabis, inhalants and other illicit drugs (heroin, cocaine, sedative-hypnotic drugs, etc.). This study found that: (1) higher socio-economic status of the family increased the likelihood of smoking and alcohol use in adolescents; (2) the prevalence of alcohol use was higher in adolescents whose mothers had a higher educational level and whose mothers and fathers drank alcohol; (3) there was a significant association between substance use and having a peer who used a substance; and (4) the prevalence of smoking was significantly higher in students who perceived their academic performance to be poor. Understanding the role and importance of psychosocial factors associated with smoking, alcohol and substance use will be crucial to develop preventive measures for adolescents.

T102C and -1438 G/A polymorphisms of the 5-HT2A receptor gene in Turkish patients with obsessive-compulsive disorder.

OBJECTIVE: This study aimed to investigate the possible association between T102C and -1438 G/A polymorphism in the 5-HT2A receptor gene and susceptibility to and clinical features of obsessive-compulsive disorder (OCD). METHOD: Fifty-eight patients with OCD and 83 healthy controls were included in the study. All patients were interviewed and rated by Yale-Brown Obsessive-Compulsive Scale. T102C and -1438 G/A polymorphisms of 5-HT2A receptor gene were determined by PCR technique in DNAs of peripheral leucocytes. RESULTS: OCD patients and healthy controls did not show significant differences in genotype distribution for both polymorphisms investigated. We found that frequencies of the TT genotype for T102C polymorphism and the AA genotype for -1438 G/A polymorphism were significantly higher in patients with severe OCD compared to those with moderate or moderate-severe OCD. CONCLUSION: The -1438 G/A and T102C polymorphisms of the 5-HT2A receptor gene are not associated with an increased risk of OCD. Our data suggest that the TT genotype of T102C and the AA genotype of -1438 G/A polymorphism might be a factor in clinical severity of OCD.

Amisulpiride augmentation in treatment resistant obsessive-compulsive disorder: an open trial.

Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder (OCD), 40% to 60% of patients who receive an adequate treatment with these agents have significant persisting symptoms. Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors (SRIs). The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD. A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study. Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses. The mean amisulpiride dose was 325 +/- 106 mg/day. The patients were assessed with the Yale-Brown obsessive-compulsive scale (Y-BOCS) at baseline and at week 12 of amisulpiride treatment. Side effects were monitored by the UKU side effect rating scale. The reduction in Y-BOCS scores between the baseline (26.7 +/- 6.3) and the end of the treatment (12.5 +/- 2.8) was statistically significant (p=0.0001). The most commonly observed side effects included weight gain (14 patients, 70%), mild sedation (13 patients, 65%) and asthenia (7 patients, 35%). This study has several limitations and, hence, the results are preliminary and require confirmation in a randomized controlled trial. In conclusion, this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD.