Satisfaction and attitude of bipolar patients regarding electroconvulsive therapy: modified or unmodified.

Objective: Ministry of Health of Turkey issued a legislation to use only modified electroconvulsive therapy (ECT) in 2005, and this study aimed to assess satisfaction and attitude of bipolar patients regarding modified and unmodified electroconvulsive therapy.Methods: A total of 100 patients (50 treated with modified electroconvulsive therapy (M-ECT) and 50 treated with unmodified ECT (UM-ECT) with a diagnosis of Bipolar Disorder (depressive or manic episode) were invited to participate in this study. Patients with euthymic mood were included. Satisfaction and attitude towards ECT were evaluated with a structured attitude questionnaire, and M-ECT and UM-ECT patients, and their subgroups (depressive vs. manic) were compared.Results: No significant differences were found between M-ECT and UM-ECT groups regarding age, sex, marital status and occupation. The majority of all patients (78%) were satisfied from treatment with ECT and with the outcome (88%), without significant differences between modified and unmodified groups. Forgetfulness (70%) and headaches (57%) occurred in all groups, with the only significant difference in forgetfulness being reported by more manic patients treated with UM-ECT. Depressive and manic patients treated with UM-ECT reported concerns of brain damage and physical harm significantly more frequently. While 86% of patients treated with M-ECT consented to a future treatment, this was significantly less in patients treated with UM-ECT (50%).Conclusions: Bipolar patients report a high degree of satisfaction treated either with modified or unmodified ECT but there was a significant difference in perception of adverse effects and willingness for receiving ECT in future.

Sexual dysfunction in obsessive compulsive disorder and panic disorder.

BACKGROUND: Clinical research has provided conflicting evidence regarding sexual dysfunction in patients with OCD and PD. This study was undertaken to assess and compare certain parameters of sexual functioning in OCD and PD patients. SUBJECTS AND METHODS: The study population consisted of 80 patients between 20 and 60 years of age with a diagnosis of OCD or PD who were followed and treated at the anxiety outpatient unit of Bakirkoy Research and Training Hospital for Psychiatric and Neurological Disorders between 2005 and 2006. The total study population comprised of 40 patients with OCD, 40 patients with PD, and 40 healthy volunteers as the control group. Of the two questionnaires used for study purposes, the first provided information on demographic data and certain parameters of sexual functioning, while the second was the validated Turkish translation of the Golombok-Rust Sexual Satisfaction Inventory with transliteral equivalence. RESULTS: Male subjects with OCD had a lower age of first masturbation and first nocturnal ejaculation. Infrequency problem among female and male patients with OCD occurred in 63.6% and 57.1%, respectively. Corresponding figures for PD patients were 36% and 38%. Thus, infrequency problem was more frequent among OCD patients. Sexual avoidance was found in 60.6% of female OCD patients and in 64% of female PD patients. Anorgasmia was detected in 24.2% of the female subjects with OCD. CONCLUSION: Sexual dysfunction unrelated to pharmacotherapy has been found to occur in OCD and PD. Assessment of sexual functioning in these individuals before treatment may help prevent deterioration of sexual function that may occur upon introduction of psychotropic medications.

Efficacy of high-dose aripiprazole for treatment-resistant schizoaffective disorder: a case report.

Aripiprazole is an atypical neuroleptic with a unique mechanism of action. According to the package insert, the maximum recommended dose for aripiprazole is 30 mg/day. In clinical practice, off-label prescribing of medications, including the use of doses that exceed the manufacturer's recommendations, is not uncommon. Most premarketing studies are designed principally to demonstrate safety, efficacy, and tolerability and often exclude many patients who are treated after a drug has been released.To report a case with treatment-resistant schizoaffective disorder in which a patient tolerated and responded to high-dose aripiprazole; an objective is to discuss the use of aripiprazole dosages at higher than those recommended in the product's labelling.

A psychotic disorder related to use of herbal preparation: case report.

This article deals with the increasing frequency with which herbal preparations are being used in Turkey. The ingredients of herbal preparations are multiple and include a variety of herbal seed and leaf-related components. Thus, it is not possible to pinpoint a specific chemical culprit without careful analysis of each. In this article, we present a case of psychotic manic state due to the herbal preparations.

The comorbidity of anxiety disorders in bipolar I patients: prevalence and clinical correlates.

The purpose of this study was to determine the prevalence of lifetime anxiety disorders in bipolar I patients in Sanliurfa, Turkey, and to assess the association between comorbidity and several demographic and clinical variables. Seventy bipolar I patients in remission were assessed by means of the Structured Clinical Interview for DSM-IV axis I Disorders-Clinician Version (SCID-I-CV), Anxiety Disorder Module in order to detect lifetime comorbid anxiety disorders. Nineteen (27.1%) bipolar I patients were diagnosed with at least one lifetime comorbid anxiety disorder. The most common anxiety disorders in this sample were obsessive compulsive disorder (12.8%) and specific phobia (12.8%), followed by panic disorder (5.7%). Anxiety disorder comorbidity appears to be associated with greater number of hospitalizations, psychotic symptoms and suicide attempts in patients with bipolar I disorder. As comorbidity has a clear impact on the course of bipolar patients, special attention to this issue should be paid when interviewing bipolar patients.

Effects of an antistigma program on medical students' attitudes towards people with schizophrenia.

People with schizophrenia are amongst the most stigmatized of those with mental illnesses. The purpose of this study was to examine whether an antistigma program which consists of education, contact, and viewing a film that depicts an individual with schizophrenia, can change attitudes towards people with schizophrenia. The antistigma program was carried out with first-year medical students (n=25). Students' attitudes towards people with schizophrenia were assessed before and after the program. In parallel, a control group of first-year medical students were questioned (n=35). Assessment was repeated after 1 month. Favorable attitudinal changes were observed in terms of 'belief about the etiology of schizophrenia', 'social distance to people with schizophrenia', and 'care and management of people with schizophrenia'. In contrast, no significant change was observed in the control group. Attitude changes tended to decrease at the 1-month follow up. These results suggest that attitudes towards schizophrenia could be changed favorably with this program. To sustain changed attitudes towards people with schizophrenia, antistigma programs should be offered on a regular basis.

Comorbid personality disorders in subjects with bipolar I disorder.

UNLABELLED: Objective. The purpose of this study was to present the frequencies of personality disorders in a sample of bipolar I patients and to investigate whether the presence of comorbid personality disorders affect the course of bipolar illness. METHODS: Seventy euthymic bipolar I patients were assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II). Bipolar patients with comorbid personality disorder were compared with those of without personality disorder comorbidity on demographic and clinical variables. RESULTS: Forty bipolar I patients (57%) had at least one comorbid personality disorder. The most common personality disorder cluster was cluster C (36%), followed by cluster B (17%) and cluster A (17%) personality disorders. The most prevalent personality disorder in the whole group was obsessive-compulsive personality disorder (21%). Patients with comorbid personality disorders had an earlier age of onset than those of without comorbidity. CONCLUSION: Although the rates of comorbid personality disorders are high in bipolar I patients, the presence of comorbidity has no relevant impact on the course of bipolar I patients except for earlier age of onset of bipolar I disorder.

Quality of life instrument for Turkish people with skin diseases.

BACKGROUND AND OBJECTIVE: To develop a new, short, self-administrated subjective quality of life (QOL) instrument for Turkish people with skin diseases. PATIENTS AND METHODS: The 11-item questionnaire of QOL instrument was developed from 200 consecutive dermatological patients' replies. The reliability and validity of the instrument was tested on data gathered from 278 patients with skin diseases attending a dermatology outpatient department and 49 normal subjects. Construct validity was assessed by an exploratory factor analyses and comparisons between patients rated severe and not severe, as well as between normal and patient groups. Reliability was assessed from the internal consistency of the scales and the correlations were made between scores from a 7-10-day retest by using intraclass correlation coefficient. RESULTS: Factor analyses found six separate dimensions of QOL involving skin disease: social life, emotional life, daily activity, symptoms, cognitive life and sexual life. In addition, 81.3% of common variance was explained by the above factors, all of which correlated with the scale scores of the instrument. The instrument scales were internally consistent (Cronbach's alpha= 0.77-0.84) and scale scores were reproducible after 7-10 days (ICC = 0.63-0.88). Significantly, correlations between scale scores and physician's assessment of the severity of the skin disease were found. Significant differences between diagnostic groups were observed with higher scores for patients with psoriasis, urticaria and acne than those with eczema in the emotional life domain (P < 0.05). In the sexual life domain, however, the eczema group had higher scores than patients with psoriasis, urticaria or acne (P < 0.01). CONCLUSION: The instrument provides valid and reliable assessments of QOL in Turkish patients with skin disease.

The effect of music on preoperative sedation and the bispectral index.

We assessed the effect of music on the level of sedation and the electroencephalograph bispectral index (BIS) during the preoperative period. Fifty-four ASA physical status I-II patients, scheduled for elective septo-rhinoplastic surgery, were included in the study. Subjects were assigned to receive either music (music group; n = 28) or no music (control group; n = 26) during the preoperative period. Sedative premedication was provided with midazolam 0.08 mg/kg IM. Observer's Assessment of Alertness/Sedation Scales (OAAS) scores and BIS values were recorded at specific time intervals. In the control group, there were more patients with an OAAS score of 1 than in the music group at 30 min after midazolam injection. In addition, there were more patients with an OAAS score of 2 in the control group than in the music group at 30-50 min. However, there were significantly more patients with an OAAS score of 3 in the music group than in the control group at 20-50 min. BIS values of the music group were also smaller than the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10-50 min in the music group, whereas BIS values decreased at 30-50 min in the control group. In conclusion, listening to music during midazolam premedication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.

The emergence of tics during escitalopram and sertraline treatment.

The selective serotonin reuptake inhibitors (SSRIs) have well-established antidepressant activity and have also demonstrated efficacy in a number of anxiety disorders, including panic disorder. The SSRIs, escitalopram and sertraline, are well-tolerated and movement disorders are rarely associated with their use. We present a case of the emergence of tics associated with escitalopram and sertraline treatment, which might be due to an imbalance in the dopaminergic neurotransmitter system.

Condolence houses in Sanliurfa: fading away of a tradition and a creative attempt to preserve it.

This article reports the results of qualitative research conducted to investigate the change in the traditional manner of giving and accepting condolences in Sanliurfa, a city with a unique sociocultural structure in the southeastern part of Turkey. Our methodology was based on direct observation of behavior and detailed, open-ended interviews with participants. This article aims to investigate the reasons for moving the condolence tradition from family homes to specially built condolence houses a decade ago and discusses the functional significance of the ceremonial events in giving and accepting condolences.

Suicide pact among three young sisters.

A suicide pact is an agreement between two or more people to kill themselves. They represent 0.6-4.0% of all suicides, the vast majority being double suicides. We present a triple suicide pact involving three young sisters. Atypical features of this case include the number of participants, their young ages, and their good health conditions. Similarities to previously reported cases include participants having family disturbances, histories of depression and borderline personality.

Association between Ala-9Val polymorphism of Mn-SOD gene and schizophrenia.

Reactive oxygen species (ROS) have been suggested to play an important role in physiopathology of schizophrenia. The major intracellular antioxidant enzymes, copper-zinc superoxide dismutase in the cytoplasm and manganese superoxide dismutase (Mn-SOD) in the mitochondria, rapidly and specifically reduce superoxide radicals to hydrogen peroxide. Polymorphisms in the genes encoding antioxidant enzymes should therefore result in predisposition to schizophrenia. The present study was performed to assess whether there is a genetic association between a functional polymorphism (Ala-9Val) in the human Mn-SOD gene in schizophrenic patients (n=153) and healthy controls (n=196) using a PCR/RFLP method. Significant differences in the genotypic distribution between schizophrenics and controls were observed. Genotypic distribution with 14 (9.2%) Ala/Ala, 106 (69.3%) Ala/Val and 33 (21.6%) Val/Val subjects in schizophrenia was different from those of controls with 46 (23.5%), 83 (42.3%) and 67 (34.2%), respectively (p<0.0001). When the patients with schizophrenia were divided into the subgroups as disorganized, paranoid and residual, there was a significant difference in genotypic distribution among the subgroups (chi2=11.35, df=4, p=0.023). This association between -9Ala Mn-SOD allele and schizophrenia suggests that -9Ala variant may have a contribution in the physiopathogenesis of schizophrenia. Further investigations are warranted in larger populations with other susceptible genes that might be associated with schizophrenia.

A case of factitious disorder involving menstrual blood smeared on the face.

This article presents a case of factitious disorder in which a female smeared menstrual blood on her face. The patient was admitted to our otolaryngology clinic complaining of bleeding from the mouth, nose, ears and eyes. This event reportedly occurred three to four times on a daily basis. She acknowledged nine prior admissions to different specialists over the last two years. Following psychiatric consultation, we diagnosed factitious disorder with predominantly physical signs and symptoms. She was started on Fluoxetine 20 mg/day and supportive interviews were organized. After diagnosis, we observed that her symptoms decreased over two months. The symptoms did not reoccur three to nine months after treatment. This case report outlines two important features. The first is that a case of this type has not been reported before, and the second feature is that this case demonstrates the effect of cultural factors greatly different from those seen in classical factitious disorder.

Plasma manganese, selenium, zinc, copper, and iron concentrations in patients with schizophrenia.

A number of essential trace elements play a major role in various metabolic pathways. Selenium (Se), manganese (Mn), copper (Cu), zinc (Zn), and iron (Fe) are essential trace elements that have been studied in many diseases, including autoimmune, neurological, and psychiatric disorders. However, the findings of previous research on the status of trace elements in patients with schizophrenia have been controversial. We studied these elements in patients with a DSM-IV diagnosis of schizophrenia and compared them with sex- and age-matched healthy controls. Plasma Cu concentrations were significantly higher (p < 0.01) and Mn and Fe concentrations were lower (p < 0.05 and p < 0.05, respectively) in schizophrenic patients than in controls. Se and Zn concentrations and protein levels did not differ between patients and healthy controls. These observations suggest that alterations in essential trace elements Mn, Cu, and Fe may play a role in the pathogenesis of schizophrenia. However, findings from trace element levels in schizophrenia show a variety of results that are difficult to interpret.

The role of the arginine-nitric oxide pathway in the pathogenesis of bipolar affective disorder.

There is a reciprocal regulation of arginase and nitric oxide synthase (NOS) in L-arginine-metabolizing pathways. Nitric oxide (NO) may be involved in some psychiatric disorders like schizophrenia, depression and bipolar affective disorder (BPAD). To our knowledge, there is no study in the literature in which the role of arginase, an important part of the arginine regulatory system affecting NOS activity, was investigated in BPAD. This study aims to investigate arginase, manganese (Mn) and total nitrite levels (a metabolite of NO) and their relationship to the arginine-NO pathway in patients with BPAD. Arginase activities, Mn and total nitrite levels were measured in plasma from forty-three patients with BPAD (Type one) and thirty-one healthy control subjects. Plasma arginase activities and Mn were found to be significantly lower and total nitrite level higher in patients with BPAD compared with controls. Our results suggest that the arginine-NO pathway is involved in the pathogenesis of BPAD.

The relationship between potency of oxidative stress and severity of depression.

BACKGROUND: Oxidative stress is one of the suggested mechanisms in major depression. OBJECTIVE: To determine the oxidative and antioxidative status of plasma of patients with major depression and to investigate whether there is a relationship between the potency of oxidative stress and the severity of depression. METHODS: To determine the antioxidative status of plasma, total and individual antioxidant levels which are total antioxidant potential (TAOP), total protein, albumin, uric acid, vitamin C and total bilirubin were measured. To determine the oxidative status, total peroxide level of plasma was measured in patients with drug-free depressive patients and compared with those of controls. Per cent ratio of total peroxide to TAOP was evaluated as oxidative stress index (OSI). RESULTS: Plasma TAOP and individual antioxidant levels were found to be lower in patients with depression than those of controls. On the contrary, the patients had high total plasma peroxide levels. OSI values of the patients were significantly higher than those of controls (P = 0.002), and a significant positive correlation between Hamilton Depression Rating Scale (HDRS) and OSI values was found (r = 0.54, P = 0.01). CONCLUSIONS: The patients with major depression are exposed to oxidative stress, and OSI may be useful to reflect the severity of the disease.

Changes in nitric oxide levels and antioxidant enzyme activities may have a role in the pathophysiological mechanisms involved in autism.

BACKGROUND: There is evidence that oxygen free radicals play an important role in the pathophysiology of many neuropsychiatric disorders. Although it has not been investigated yet, several recent studies proposed that nitric oxide (NO) and other parameters related to oxidative stress may have a pathophysiological role in autism. METHODS: We assessed the changes in superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities and thiobarbituric acid-reactive substances (TBARS) levels in plasma as well as NO levels in red blood cells (RBC) in patients with autism (n=27) compared to age- and sex-matched normal controls (n=30). RESULTS: In the autistic group, increased RBC NO levels (p<0.0001) and plasma GSH-Px activity (p<0.0001) and unchanged plasma TBARS levels and SOD activity were detected. CONCLUSIONS: These findings indicate a possible role of increased oxidative stress and altered enzymatic antioxidants, both of which may be relevant to the pathophysiology of autism.