Levels of TNF alpha, Soluble TNF Receptors (sTNF-R1, sTNF-R2) in Bipolar Disorder.

INTRODUCTION: Current evidence suggests that pro-inflammatory cytokines, particularly tumor necrosis factor alpha (TNF-α) may play an important role in the pathophysiology of bipolar disorder (BD). Our study aims to compare BD patients and controls in terms of serum TNF-α, soluble tumor necrosis factor receptor 1 and soluble tumor necrosis factor receptor 2 (sTNF-R1, sTNF-R2) levels in different phases of BD. METHODS: Eighty-three patients with BD type 1 (27 manic, 22 depressive and 34 euthymic) and twenty-nine healthy controls were included in the study. Serum levels of TNF-α, sTNF-R1, sTNF-R2 levels were evaluated with ELISA kit. RESULTS: Levels of sTNF-R1 were showed a statistically significant difference between groups. Levels of sTNF-R1 were higher in depression or mania patients than euthymia patients and control subjects. A statistically significant difference in the serum level of sTNF-R1 between patients in acute episode (mania and depression) group and stabile (patients in euthymic episode and controls) group was found in logistic regression analysis. The probability of having acute episode increased threefold for each unit increase in serum level of sTNF-R1. There was no statistically significant difference between the mean serum values of TNF-α and sTNF-R2 between the groups. CONCLUSIONS: sTNF-R1 production was different between acute episode patients and controls or stable BD patients. The result of this study confirms that TNF-R1 may be a state marker representing disease activity for BD.

A Web-based Game for Teaching Facial Expressions to Schizophrenic Patients.

BACKGROUND: Recognizing facial expressions is an important social skill. In some psychological disorders such as schizophrenia, loss of this skill may complicate the patient's daily life. Prior research has shown that information technology may help to develop facial expression recognition skills through educational software and games. OBJECTIVES: To examine if a computer game designed for teaching facial expressions would improve facial expression recognition skills of patients with schizophrenia. METHODS: We developed a website composed of eight serious games. Thirty-two patients were given a pre-test composed of 21 facial expression photographs. Eighteen patients were in the study group while 14 were in the control group. Patients in the study group were asked to play the games on the website. After a period of one month, we performed a post-test for all patients. RESULTS: The median score of the correct answers was 17.5 in the control group whereas it was 16.5 in the study group (of 21) in pretest. The median post-test score was 18 in the control group (p=0.052) whereas it was 20 in the study group (p<0.001). CONCLUSIONS: Computer games may be used for the purpose of educating people who have difficulty in recognizing facial expressions.

Evaluation of the usability of a serious game aiming to teach facial expressions to schizophrenic patients.

In some psychological disorders such as autism and schizophrenia, loss of facial expression recognition skill may complicate patient's daily life. Information technology may help to develop facial expression recognition skill by educational software and games. We designed and developed an interactive web-based educational program with which we performed a usability study before investigating its effectiveness on the schizophrenia patients' ability of emotion perception. The purpose of this study is to describe the usability evaluation for a web-based game set that has been designed to teach facial expressions to schizophrenic patients. The usability study was done at two steps; first, we applied heuristic evaluation and the violations were rated in a scale from most to least severe and the major problems were solved. In the second step, think-aloud method was used and the web site was assessed by five schizophrenic patients. Eight experts participated in the heuristic evaluation, in which a total of 60 violations were identified with a mean severity of 2.77 (range: 0-4). All of the major problems (severity over 2.5) were listed and the usability problems were solved by the development team. After solving the problems, five users with a diagnosis of schizophrenia used the web site with the same scenario. They reported to have experienced minor, but different problems. In conclusion, we suggest that a combination of heuristic evaluation and think-aloud method may be an effective and efficient way for usability evaluations for the serious games that have been designed for special patient groups.