A Severe Neuroleptic Malignant Syndrome Treated with Daily Electroconvulsive Therapy: A Case Report. / Günlük Elektrokonvülzif Terapi ile Tedavi Edilen Siddetli Nöroleptik Malign Sendrom: Bir Olgu Sunumu.

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition caused by dopamine modulating medications, particularly antipsychotics. First-line treatments of neuroleptic malignant syndrome are supportive care, discontinuation of the offending agent and pharmacotherapy. In drug-resistant and severe situations, electroconvulsive therapy (ECT) is recommended as well. In this paper we present a 23-year old male with bipolar disorder who was treated with multiple injections of zuclopenthixol long acting and depot forms for a recent manic episode and developed NMS. The patient was transferred to an intensive care unit, medical management was initiated including benzodiazepines, bromocriptine and dantrolene. Due to the inadequate response after several days, ECT (bitemporal electrode placement, briefpulse, on a daily basis) was initiated. After 17 sessions, NMS relieved and there was no need for maintenance ECT. The patient is under follow-up care for 3 years with no cognitive and physical sequela. Keywords: Electroconvulsive therapy, neuroleptic malignant syndrome, bipolar disorder.

Effects of Age, Gender and Education on Phonemic and Semantic Verbal Fluency. / Yas, Cinsiyet ve Egitim Düzeyinin Fonemik ve Semantik Sözel Akicilik Testi Puanlari Üzerinde Etkisi.

OBJECTIVE: The aim of this study was to obtain normative data for Verbal Fluency Test and investigate the effects of age, gender, and education on verbal fluency in native Turkish-speaking individuals. METHOD: A pilot study was conducted to determine 3 letters with differing levels of difficulty for completing the phonemic fluency task. First names and animals were chosen for the semantic fluency task, and an alternating semantic task (first name-animal) was also used. In total, 415 participants (208 male and 207 female) were recruited and stratified based on the age and education levels. RESULTS: Level of education had a main effect on all verbal fluency tasks; people with higher education performed better. Age and gender were found to have no effect on phonemic verbal fluency. Only the < name production task was affected by gender, women performed better. Younger age groups produced more words in name generation and semantic alternating fluency tasks. CONCLUSION: The effects of age, gender and education on verbal fluency are in accordance with many previous reports. Analysis of various errors were also conducted. Results for Turkish are presented and discussed in the light of literature.

The Validity and Reliability of the Turkish Version of MacArthur Competence Assessment Tool for Treatment Decision: Correlates of Competence in Schizophrenia Patients.

INTRODUCTION: Informed consent is an indispensable condition of the clinical practice for the provision of health care. The main objective of this study is to translate the MacArthur competence assessment tool for treatment (MacCAT-T) into Turkish and evaluate the validity and reliability of the Turkish version in schizophrenia patients and healthy control subjects. METHODS: In this cross-sectional study, 30 hospitalized schizophrenia patients and 25 healthy subjects were assessed with MacCAT-T, Mental Competence Evaluation Form for Assessment of Competency (MCEF), Positive and Negative Syndrome Scale, Beck Depression Inventory, Mini Mental State Examination, Wechsler Adult Intelligence Scale (WAIS) - Similarities subtest and the Schedule for Assessing the Three Components of Insight. Psychometric properties of MacCAT-T were examined by intra-class correlation coefficients and Cronbach's alpha values. RESULTS: Intra-class correlations ranged between 0.83 and 0.99 for four subscales of the tool. Cronbach alpha value of MacCAT-T was found 0.89. Severity of psychopathology and indices of insight were found to be negatively correlated with the subscales of the tool. WAIS-Similarities subtest scores were found to be positively correlated with understanding and reasoning subscales of MacCAT-T. CONCLUSION: The Turkish version of MacCAT-T is a valid and reliable instrument for Turkish patients. The severity of psychopathology, insight and executive functions were shown to be significantly related to the decision making capacity in patients with schizophrenia.

Validation of Montreal Cognitive Assessment and Discriminant Power of Montreal Cognitive Assessment Subtests in Patients With Mild Cognitive Impairment and Alzheimer Dementia in Turkish Population.

Montreal Cognitive Assessment (MoCA) is a new cognitive tool developed for screening mild cognitive impairment (MCI). The authors examined validity of MoCA and discriminating power of subtests in a Turkish population comprising of 474 participants (246 healthy controls, 114 subjects with MCI and 114 subjects with dementia). The ANCOVAs showed that age and education had a main effect on MoCA scores. Cut scores were computed according to different education levels. The overall cut-off values for MCI and dementia were found to be lower compared to western studies. MoCA was found to have good internal consistency. The subtests most useful in discriminating MCI from healthy controls were recall, visuospatial and language, while in discriminating dementia from MCI were visuospatial, orientation and attention subtests. The results demonstrated that MoCA is a valid and reliable instrument in screening MCI, and compared with the MMSE, MoCA was proved to have superior sensitivity and specificity in detecting MCI.

Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

OBJECTIVE: Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. MATERIALS AND METHODS: A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. RESULTS: The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. CONCLUSIONS: Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey.

OBJECTIVE: Postpartum depression (PPD) is an important health issue that affects not only mothers, but also entire families. Postpartum follow-up should address emotional and psychological issues, as well as physical issues, especially in those at risk. This study aimed to determine the incidence of PPD and the associated risk factors in a group of new mothers undergoing routine follow-up at an urban maternity clinic. METHODS: This is a cross-sectional study investigating the relationship between PPD and various factors. A total of 187 women that presented to a university hospital for routine postpartum follow-up 4-6 weeks post delivery were recruited consecutively. The mothers were administered a sociodemographic form that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child-related factors) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The incidence of PPD based on EPDS scores was 28.9% (scores > 12 were defined as PPD). Unplanned/unintended pregnancy, bottle-feeding only, mother's lack of satisfaction with the baby's sleep pattern, lack of family support for baby care, lack of satisfaction with the marital relationship, and family violence were significantly correlated with PPD (P < 0.05). Multiple logistic regression showed that bottle-feeding, lack of family support, lack of satisfaction with the marital relationship, and family violence were the primary factors that significantly increased the risk of PPD. CONCLUSIONS: The findings show that the PPD occurs in almost one-third of women and that, among the risk factors, sociocultural factors were the most strongly associated with PPD.

A challenging case of syndrome of inappropriate secretion of antidiuretic hormone in an elderly patient secondary to quetiapine.

Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an uncommon complication of treatment with centrally acting drugs including selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. Antipsychotics are commonly used for the treatment of behavioral and psychiatric symptoms in elderly patients with dementia, and the use of those agents is increasing. Here, we report an elderly man who developed hyponatremia after treatment with medications for depression and agitation.