The effects of the estrus cycle and citalopram on anxiety-like behaviors and c-fos expression in rats.

In rats, hormonal fluctuations during the estrus cycle may have numerous behavioral and neurobiological consequences. The aim of this study was to investigate the effects of estrus cycles and citalopram on behavior, ultrasonic vocalizations, anxiety levels, and c-fos expression in rats. With this aim, the rats were grouped into two: (1) a control group (n=16) and (2) a citalopram group (n=16), which received daily intraperitoneal 20mg/kg citalopram from baseline (D0) to the 10th day (D10). Behavioral analysis and ultrasonic vocalization (USV) recordings were made on D0 and D10. Next, the rats were further subgrouped according to estrus phases identified through a vaginal smear (8 proestrus rats and 8 non-proestrus rats, in each group). The rat's anxiety levels were analyzed with an elevated plus maze (EPM), and their c-fos expression was measured at the cingulate cortex, the amygdala, and the paraventricular thalamic nucleus. Our results showed that the citalopram group showed significantly more grooming behaviors on D10 than the control group (p=0.002). USVs on D0, D10 and during the EPM did not show any significant differences between the groups. Proestrus rats in the control group showed significantly less anxiety-like behavior during the EPM than the non-proestrus rats in the control group (p=0.028 for time spent in open arms, and p=0.011 for entries into open arms). There was no significant difference in anxiety-like behavior between the control and citalopram groups, and between the proestrus and non-estrous rats in the citalopram group. C-fos expression at the amygdala (p=0.013) and the paraventricular thalamic nucleus (p=0.014) was significantly inhibited in the citalopram group. We concluded that estrus cycles have a significant effect on anxiety levels in rats, which may be suppressed behaviorally and neurobiologically by citalopram.

Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

AIMS AND OBJECTIVES: To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful. BACKGROUND: Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities. DESIGN: Prospective cohort study. METHODS: Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session. RESULTS: Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors. CONCLUSION: Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame. RELEVANCE TO CLINICAL PRACTICE: Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Effects of the adverse life events and Disrupted in Schizophrenia-1 (DISC1) gene polymorphisms on acute symptoms of schizophrenia.

The aim of this study was to evaluate the effects of traumatic childhood events and recent adverse life events, as well as the Disrupted in Schizophrenia-1 (DISC1) gene polymorphisms on types of last acute symptoms of patients with schizophrenia. Hundred patients with schizophrenia were given the Childhood Trauma Questionnaire, the Social Readjustment Rating Scale, Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scale (BPRS), and Calgary Depression Scale for Schizophrenia (CDSS). The patients' and healthy controls' DISC1 gene was evaluated for the -274G>C, c.791G>A, and c.2110A>T polymorphisms. There was no statistically significant difference with regard to the DISC1 gene polymorphisms between patient and healthy control groups. No significant relationship was found between the -274G>C, c.791G>A, and c.2110A>T haplotypes and development of different acute symptoms of schizophrenia. Having a recent stressful life event significantly affected SAPS (95% confidence interval [CI]=-67.547, -21.473; p=0.00) and BPRS-1 scores (95% CI=-51.405, -6.885; p=0.01), whereas emotional abuse at childhood significantly affected SANS scores (95% CI=-37.300, -10.401; p=0.00). This study shows that features of acute symptoms in schizophrenia are not influenced by the polymorphisms on the DISC1 gene, but are influenced by recent adverse life events and emotional abuse at childhood.

Neurobiology of repression: a hypothetical interpretation.

Freud lived in a time when technology was incapable of explaining the biological correlates of the mental processes he described in psychoanalytic theory. During the last two decades, advances in neuroimaging methods and neuroscience have provided new insights for understanding mind-brain collaboration. Neurobiological underpinnings of psychoanalytical concepts have been an area of interest in recent years. This paper will suggest a new hypothesis for neurobiology of repression. This hypothesis will be discussed with the help of our knowledge about neurobiological mechanisms underlying perception of the emotional significance of an event, memory formation of an emotionally arousing stimulus, role of prefrontal cortex in modulation of subcortical information, neural mechanisms of suppression and molecular mechanisms of memory erasure. We suggest that dorsolateral prefrontal cortex, and especially its caudal part plays a major role for repression of childhood traumatic events. Possible molecular mechanism of memory erasure in repression is long term depression of glutamatergic neurotransmission between prefrontal cortex- thalamus- limbic system.

Does single cortical spreading depression elicit pain behaviour in freely moving rats?

INTRODUCTION: Behavioural animal studies are critical, particularly to translate results to human beings. Cortical spreading depression (CSD) has been implicated in migraine pathogenesis. We aimed to investigate the effects of CSD on the behaviour of freely moving rats, since available CSD models do not include awake animals. MATERIALS AND METHODS: We developed a new model to induce single CSD by applying topical N-methyl-D-aspartate (NMDA) and employed a combination of an automated behavioural analysis system, video camera and ultrasonic vocalisation (USV) calls for the first time. Electrocorticograms were also studied during CSD in freely moving rats. Behaviour associated with cephalic pain was assessed in a group of rats that received sumatriptan. Cortical c-fos immunoreactivity was performed in order to confirm CSD. RESULTS: NMDA induced single CSD in ipsilateral cortex, evoked freezing behaviour (P < 0.01) and increased the number of wet dog shakes (WDS; P < 0.01). Grooming, locomotion, eating, drinking, and circling were not significantly altered among groups. Ultrasonic vocalisations compatible with pain calls (22-27 kHz) were only detected in 3 out of 25 rats. Sumatriptan did not significantly reduce the freezing behaviour. CSD induced significant c-fos expression in ipsilateral cerebral cortex and amygdala (P < 0.01). CONCLUSIONS: CSD induces freezing behaviour by invoking anxiety/fear via amygdala activation in freely-moving rats. Single CSD is unlikely to lead to severe pain in freely-moving rats, though the development of mild or vague pain cannot be excluded. The relevance of rat behavioural responses triggered by CSD to migraine symptoms in humans needs further evaluation.

Investigation of serotonin transporter gene promoter (5-HTTLPR) and intron 2 (variable number of tandem repeats) polymorphisms with suicidal behavior in a Turkish population.

The serotonin (5-hydroxytryptamine) transporter (5HTt) gene has been reported to be associated with suicidal behavior. In this study, we have investigated the 5' promoter region (i.e., 5HTt gene-linked polymorphic region [5-HTTLPR]) and a 17-base pair variable number of tandem repeats polymorphism in the 5HTt gene for potential association with suicidal behavior in a Turkish population. Genotypes were determined for 182 subjects of suicide (86 attempted suicide and 96 completed suicide) and 181 healthy control subjects. Our results showed that allele frequencies at individual loci were not significantly different in the two groups. This absence of altered individual locus haplotype (allele) frequency suggests the lack of a significant genetic contribution by the 5-HTTLPR or variable number of tandem repeats variations to the expression of suicidal tendencies. However, our linkage disequilibrium analyses indicated that there may be a greater risk for suicidal behavior in carriers of the S10 and L12 alleles of 5-HTTLPR.

A prospective study of serotonin transporter gene promoter (5-HTT gene linked polymorphic region) and intron 2 (variable number of tandem repeats) polymorphisms as predictors of trauma response to mild physical injury.

The aim of this study was to examine the effect of both promoter and intron polymorphisms of the serotonin transporter (5HTT) gene on posttraumatic stress disorder (PTSD) development. For this purpose, two polymorphisms of the 5-HTT gene, which are found in the promoter (5-HTT gene-linked polymorphic region) and second intron (variable number of tandem repeats) of the gene, were analyzed in 100 patients who were admitted to the Emergency Department after a mild physical trauma. None of the 5-HTT polymorphisms studied have an effect on PTSD development after a mild physical injury, but having L allele for 5-HTT gene-linked polymorphic region may cause milder hyperarousal symptoms in those patients who have developed PTSD.

Farewell to the world: suicide notes from Turkey.

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

Relation of temperament and character properties with clinical presentation of bipolar disorder.

OBJECTIVES: The purpose of this study was to examine the underlying temperament and character properties of patients with bipolar disorder and explore the possible connections between these properties and clinical presentation of the illness. METHODS: The sociodemographic and clinical properties of 90 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their temperament and character features were evaluated by using Temperament and Character Inventory and results were compared with 90 age- and sex-matched healthy controls and between patients with different clinical properties. RESULTS: Patients' scores on subscales of self-directedness and cooperativeness were significantly lower compared with controls. Significant associations were found between Temperament and Character Inventory subtitles and comorbid personality disorder, number of episodes, subtype of the first episode, rapid cycling, and previous suicide attempt. CONCLUSIONS: Temperament and character features of patients with euthymic bipolar disorder show some significant differences compared to the healthy population and may vary according to different clinical presentations.

Prolongation of clozapine-induced leukopenia with olanzapine treatment.

Clozapine is a well-known antipsychotic to cause fatal agranulocytosis but there are only a few case reports about the risk of leukopenia and agranulocytosis associated with other atypical antipsychotics. Olanzapine has structural pharmacological similarities to those of clozapine and reports about haematological adverse effects of olanzapine include three groups: the first group includes cases of olanzapine-induced neutropenia, the second informing that olanzapine is safe after clozapine induced agranulocytosis and the third group forms prolongation of clozapine-induced leukopenia with olanzapine use. The aim of this paper is to report a case of prolongation of clozapine-induced leukopenia despite olanzapine treatment and discuss leukopenia caused by atypical antipsychotic use in the light of recent and limited literature.

[The relationship between mood disorders and temperament, character and personality]. / Duygudurum bozukluklari ile huy, karakter ve kisilik iliskisi.

The terms temperament, character and personality have been used almost synonymously despite their different meanings. Hippocratic physicians conceptualized illness, including melancholia, in dimensional terms as an out-growth of premorbid characteristics. In modern times, full-scale application of this dimensional concept to psychiatric disorders led Kraepelin, Schneider and Kretschmer to hypothesize that the 'endogenous psychoses are nothing other than marked accentuation of normal types of temperament'. Akiskal's 'soft-bipolarity' and 'affective temperaments' concepts and Cloninger's psychobiological model of temperament and character, which includes four temperament and three character dimensions, are examples of this dimensional approach from the last two decades. Hypotheses concerning the relationship between personality disorders and mood disorders have been described, but it is likely that a single unitary model would not adequately capture the complexity inherent in the relationship between mood and personality disorders. The DSM multiaxial approach to diagnosis encourages the clinician to distinguish state (Axis I) from trait (Axis II) features of mental disorders. Categorical systems like DSM have been criticised because of their inability to mention temperament, character and personality features. In this review, examples of dimensional approaches to mood disorders are given and discussed under the influence of temperament, character and personality disorders. For this purpose, literature from 1980 to 2004 has been reviewed through Pub/med, using the following key words.

Prognosis of postpartum psychiatric disorders in a Turkish sample.

Objective The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course. Methods The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis. Results Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up. Conclusion These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.

[A male anorexia nervosa case and its discussion from dynamic point of view]. / Bir Erkek Anoreksiya Nervoza Olgusu ve Dinamik Açidan Tartisilmasi.

In this case report, we represent a male anorexia nervosa case and discuss its psychodynamics in the frame of psychoanalytic theories. Males account for %5-15 of all eating disorders. History of a criticism or a teasing for fatness by relatives or friends is very common in males before the onset of the illness. Males who are in occupations or athletic pursuits that emphasize body weight, or who work in potential high-risk jobs, and who are homosexual are at increased risk for eating disorders. Potential high risk jobs include appearance-based jobs, jobs traditionally held by women and food related jobs. Comorbid psychiatric disorders, mainly depression and anxiety disorders, and especially for bulimic males, substance-related disorders and cluster B personality traits with marked impulsivity are common. When family dynamics are considered, a father who is psychologically distant from his son, and an "over-protective, over-involved and over-dependent" mother have been described. Separation difficulties and lack of boundaries within covertly conflictual relationships have been noted in a number of clinical reports. The only difference in clinical presentation between males and females is; males rarely use medicine in order to lose weight and weight changes throughout the illness are more common in males. In this case report, a male anorexia nervosa case's psychodynamics are discussed under the influence of his psychiatric illness and his childhood history.