Endocan: A novel biomarker of endothelial dysfunction in depression?

Endocan is a proteoglycan secreted from endothelium upon endothelial damage. Since depression is associated with higher inflammation and oxidative stress to the vascular endothelium, endothelial dysfunction is prevalent and it is one of the responsible mechanisms for increased cardiovascular morbidity and mortality in depressive disorders. This study aimed to investigate endocan levels in patients with depression (either bipolar or unipolar) and healthy controls to evaluate the projected endothelial injury. We included nonsmoker patients without comorbid inflammatory conditions: 31 with Bipolar Disorder Depression (BDD), 30 with Major Depressive Disorder (MDD) and 25 healthy controls (HC). The severity of depression was assessed with the Hamilton Depression Rating Scale (HDRS). Ultimately, serum endocan levels were significantly higher in patients with BDD than in patients with MDD (p < .000) and HCs (p < .000). Also, patients with MDD had significantly higher endocan levels than HCs (p < .000). The AUC value for the endocan to differentiate patients with depression from controls was 0.990 (95% CI: 0.971-1.000; p < .001) with sensitivity and specificity of 98.4 and 100%, respectively, and an optimal cut-off value of 316.92 ng/L. Serum endocan levels showed a mild positive correlation with HDRS scores (r = 0.372, p = .039) in the BDD group but not in the MDD group (r = -0.242, p = .20). Patients with BDD had higher endocan levels than MDD; this finding, while preliminary, could be an implication of higher endothelial dysfunction in BDD.

Examination of antimicrobial effect of fluoxetine in experimental sepsis model: An in vivo study.

Since most infectious diseases can develop into sepsis, it is still a major medical problem. Some in-vivo studies showed promising properties of fluoxetine in the treatment of infections. This study aims the antimicrobial effect of fluoxetine on the inflammatory process used in the treatment of sepsis-modeled rats. Besides, to investigate the efficacy of fluoxetine on modifying the antibiotic effect of imipenem in the inflammatory response. An experimental sepsis model was divided into negative control, positive control, fluoxetine 5 mg/kg, imipenem 60 mg/kg, and combined (fluoxetine; imipenem). Procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), lactate, myeloperoxidase activity (MPO), the inflammation markers interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor-alfa (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) levels were measured by enzyme-linked immunosorbent assay method. Oxidative stress markers, total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), and native thiol (NT) were measured using photometric methods. Oxidative stress index (OSI) was calculated according to TAS and TOS levels. The statistical analysis was performed by Statistical Package for Social Sciences version 22.0. After treatment with fluoxetine, imipenem, and combined groups, IL-1ß, IL-6, TNF-α, MPO activity, MCP-1, hs-CRP, PCT, lactate, and the oxidative stress markers OSI, and disulfide levels were decreased (p < 0.05). The TT, NT, and TAS levels significantly statistically increased (p < 0.05). This research demonstrates that fluoxetine has effects as anti-inflammatory and antioxidant, and the combined treatment with antibioticum imipenem indicates positive synergistic effects in the experimental sepsis model.

Predictors of long-term anxiety and depression in discharged COVID-19 patients: A follow-up study.

BACKGROUND: Patients who were hospitalized for coronavirus disease 2019 (COVID-19) faced an extremely stressful experience that challenged their mental health and the long-term effects are not definitely known yet. AIM: To identify both the course of mental symptoms (anxiety and depressive symptoms) and the related risk factors of recovered patients at the 20-22 mo follow-up. METHODS: One hundred and seventy-two patients were enrolled. The patients were evaluated with a telepsychiatry interview and the Hospital Anxiety and Depression Scale (HADS). Sociodemographic and clinical features were analyzed by regression analysis. RESULTS: The mean HADS-Anxiety (HADS-A) score was 9.08 ± 4.90, and the mean HADS-Depression (HADS-D) score was 8.55 ± 4.39. The mean HADS-A (P = 0.484) and HADS-D (P = 0.011) scores were increased compared to scores during hospitalization. Being over 50 years old, having lower financial status, and being vaccinated were associated with symptoms of depression (adjusted R 2 = 0.168) while being over 50 years old, female sex, being vaccinated, and dyspnea were associated with higher anxiety (adjusted R 2 = 0.245). CONCLUSION: To prevent the deterioration of mental health, psychiatrists should play an active role in identifying emerging mental problems as soon as possible, more vulnerable groups should be characterized, and psychological support should be sustained after discharge.

The relation of optical coherence tomography findings with oxidative stress parameters in patients with bipolar disorder and unaffected first-degree relatives.

BACKGROUND: We aimed to evaluate the optical coherence tomography(OCT) findings and oxidative stress parameters in patients with bipolar disorder(BD) and their unaffected first-degree relatives(FDRs) and to explore OCT findings and oxidative stress parameters as potential endophenotype candidates. METHODS: Fifty patients with BD, 40 FDRs of BD, and 50 healthy controls(HCs) were included. OCT was performed to measure peripapillary retinal nerve fiber layer(RNFL), ganglion cell layer(GCL), inner plexiform layer(IPL), central macular, and minimum foveal thicknesses(CMT and MFT), choroidal thickness(ChT). 4-hydroxy-2-nonenal(HNE), total thiol(TT), native thiol(NT), total oxidant status(TOS), total antioxidant status(TAS), disulfide(DIS) and oxidative stress index(OSI) were measured from serum samples. RESULTS: TOS was higher patients with BD and FDRs than HCs (p < .001 and p = .012, respectively). OSI, DIS, HNE levels were higher patients with BD and FDRs than HCs (p < .001). TAS, TT, NT levels were lower patients and FDRs than HCs (p < .001). MFT of patients was thinner than HCs (p = .001). CMT of patients was thinner than HCs (p = .006); the same trend was observed in FDRs but did not reach the statistical significance level (p = .07). The groups did not differ on RNFL and choroidal thickness or GCL and IPL volume. LIMITATIONS: Evaluation of only a few retinal layers. CONCLUSIONS: TOS, TAS, OSI, TT, NT, DIS, HNE can be useful endophenotype biomarkers in BD. Among the OCT findings, CMT was determined as the closest parameter to being an endophenotype biomarker. Our study corroborates that oxidative stress parameters are more effective than OCT findings in endophenotype studies.

State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey.

OBJECTIVES: During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors. METHOD: Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety. RESULTS: A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women's state and trait anxiety were significantly higher than men's. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others. CONCLUSIONS: At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.

Eating behaviors, depression, and anxiety levels of pre bariatric surgery patients with obesity comorbid with or without Attention deficit and hyperactivity disorder: ADHD or Major Depression? Which is more related with eating behaviors?

OBJECTIVE: A high rate of attention deficit and hyperactivity disorder (ADHD) has been reported in patients undergoing obesity treatment. It is controversial whether ADHD solely or its comorbid disorders account for eating behaviors associated with obesity. METHODS: After presurgery psychiatric assessment, 100 severely obese patients (50 with ADHD and 50 without ADHD) were administered Adult Attention Deficit Hyperactivity Disorder Self-Report Scale(ASRS), Wender Utah Rating Scale(WURS), Three-Factor Eating Questionnaire(TFEQ), and Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI). RESULTS: Patients with obesity and ADHD had significantly greater emotional eating, susceptibility to hunger, depression, and anxiety but less restraint of eating scores than those without ADHD. Disinhibition of eating scores and presence of Binge Eating Disorder(BED) did not differ significantly between ADHD and non-ADHD groups. Obese patients with major depression had significantly higher ASRS, WURS, TFEQ, BAI scores, disinhibition of eating control, emotional eating, susceptibility to hunger, and diagnosis of BED than nondepressed ones. CONCLUSIONS: Major depression and anxiety disorder have associations with disinhibition of eating control, emotional eating, susceptibility to hunger and BED, ADHD. Disinhibition of eating and BED did not differ according to the presence of ADHD; thus, depression was associated with eating control on more constructs than ADHD in our study.

Can we predict who will be more anxious and depressed in the COVID-19 ward?

OBJECTIVE: Hospitalized patients with COVID-19 are at high risk for anxiety and depression, but most studies about mental health during the pandemic included the general public, healthcare workers, and students. We aimed to explore the anxiety and depression levels, prevalence and predictors in patients hospitalized with COVID-19. METHODS: In this cross-sectional, exploratory study, sociodemographic and clinical features of 281 patients with confirmed COVID-19 were explored. Patients underwent a comprehensive psychiatric assessment and the Hospital Anxiety and Depression Scale (HADS) was administered through a telephonic interview. RESULTS: The mean age of the participants was 55.0 ±â€¯14.9 years. One hundred forty-three (50.9%) patients were male, and 138 (49.1%) were female. Ninety-eight (34.9%) patients had significant levels of anxiety and 118 (42.0%) had significant levels of depression. Female gender, staying alone in a hospital room, early days of hospital stay, and any lifetime psychiatric disorder was associated with symptoms of anxiety. Being over 50 years of age, staying alone in a hospital room, and NSAID use before the week of hospital admission were associated with symptoms of depression. Anxiety and depression levels were lower when family members who tested positive for COVID-19 stayed in the same hospital room during treatment. CONCLUSION: Women, patients >50 years, patients who used NSAIDs before hospital admission, and those with lifetime psychiatric disorders may be at risk for anxiety and depressive symptoms in the COVID-19 ward. Allowing family members with COVID-19 to stay in the same hospital room may be associated with lower anxiety and depression levels.

Sialorrhoea associated with sertraline use.

INTRODUCTION: Sialorrhoea, which has been defined as excessive amount of saliva in the mouth, can be a debilitating symptom. Psychoactive drugs may cause an increase or decrease in saliva secretion. Antidepressant drugs, especially tricyclic antidepressants and less often serotonin reuptake inhibitors, are often associated with a decrease in salivation and the complaint of dry mouth. CASE PRESENTATION: A 46-year-old male patient with complaints of being depressed, lack of motivation, irritability and difficulty in falling asleep was started on sertraline treatment and had trouble with sialorrhoea after the dose increase, without other causes of hypersalivation. DISCUSSION: We could not find report of any case with antidepressant-associated sialorrhoea in the literature. Future cases may support a relationship between sertraline and sialorrhoea.

Haloperidol-related neutropenia.

Phenothiazines like antipsychotics have been known to cause neutropenia, but this has been reported very rarely with haloperidol. A 20-year-old male patient admitted to emergency service (emergency room) with shortness of breath, chest pain, and anger. He was diagnosed with pneumonia and prescribed moxifloxacin. After 2 days with antibiotic, he readmitted. Left lung pneumothorax was detected, and thorax computerized tomography was requested. However, he opposed and beated one of the hospital officials. The diagnosis of manic episode due to antibiotic moxifloxacin was considered. The tube thoracostomy had to be done, and antibiotic therapy was stopped. Haloperidol 10 mg/day and biperiden 4 mg/day injections were administered because he continued to resist medical interventions. After haloperidol, his leukocyte count decreased. He responded well to filgrastim (Neupogen) and blood transfusions, so a drug-related cause of neutropenia has been suspected. He was switched from haloperidol to quetiapine 300 mg twice a day. His white blood cell count returned to normal levels.

Duloxetine Induced Hyponatremia. / Duloksetine Bagli Hiponatremi.

Hyponatremia can be asymptomatic or have a wide range of clinical presentations such as headaches, muscle cramps, nausea, seizures, coma, cerebral edema and may even result in death. Despite it has been suggested that duloxetine has a relatively less risk of hyponatraemia, the number of case reports are increasing. A 45- year old female patient with complaints of fear, anxiety, sleeplessness and headache was started on duloxetine (30 mg/day). In the first week of the treatment, she was admitted to the emergency service with dizziness, dry mouth, polyuria and polydipsia. She had to be transferred to the intensive care unit because of agitation, loss of consciousness and a generalized tonic-clonic seizure. Blood levels of Sodium (Na+), Potassium (K+) and Chlorine (Cl-) were, respectfully, 121 mmol/L, 2.7 mmol/L and 87 mmol/L. Brain imaging displayed cerebral edema. Electrolyte levels were regulated with saline infusions. Amitriptyline was initiated for the ongoing headache and anxiety. In outpatient visits, hyponatremia did not recur in the following 3 months. Low dose duloxetine was associated with severe hyponatremia signs and symptoms in an individual who was not previously considered as high risk for hyponatraemia. The patient's history did not reveal any complaints related to hyponatremia when she was treated with sertraline two years ago. Based on these, we discussed the risk factors for hyponatremia and risky antidepressant classes.

Death anxiety in patients with myocardial infarction or cancer.

OBJECTIVE: The aim of this study was to find out the level of death anxiety among 3 groups: patients with acute myocardial infarction, patients with cancer and healthy individuals in two training and research hospitals; also to evaluate its relationship with several sociodemographic and clinical variables. MATERIALS AND METHOD: This study was conducted with one hundred and eighty persons (108 male, 72 female) who have been referred to cardiology or oncology departments and the healthy individuals. Participants completed sociodemographic and clinical data form, State and Trait Anxiety Inventory (STAI-I, STAI-II), Thorson Powell Death Anxiety Scale (TPDAS), Death Depression Scale (DDS). RESULTS: Participants included in the present study were 40% female with an average age of 53.48 for whole group. The mean TPDAS score for patients with AMI was 51.60 ±â€¯16.40, for patients with cancer 37.10 ±â€¯10.23 and for healthy individuals 43.40 ±â€¯13.35. In AMI group there were positive correlations between STAI-I and TPDAS, DDS scores and also between STAI-II and DDS. In cancer group positive correlations were between STAI-I, II and TPDAS, DDS. TPDAS and DDS were positively correlated in all three groups. Women and participants who were unemployed scored higher on DDS. CONCLUSION: In this study patients with AMI had higher death anxiety than patients with cancer or healthy individuals. Generally death anxiety was related with education, employment and socioeconomic status. Prospective studies carefully searching for different variables in different medical groups would reveal and help us to understand the importance of death anxiety and its impact on courses of physical and mental disorders.

Edema facial y bilateral de piernas en un paciente tratado con quetiapina / Facial and bilateral leg edema in a patient using quetiapine

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Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow.

BACKGROUND: The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF). METHODS: In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient. RESULTS: The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis. CONCLUSION: Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.