Serum DHEA-S, Testosterone and Cortisol Levels in Female Patients with Schizophrenia.

OBJECTIVE: To compare the relation symptom severity and testosterone levels, and DHEA-S and cortisol in premenopausal women with schizophrenia and an age- and sex-matched control group. METHODS: Thirty-two women with schizophrenia and 32 age- and sex-matched healthy controls were included in the study. All participants were aged between 20 and 45 years, and their previous treatments were olanzapine (n=14) and quetiapine (n=18). Symptom severity was assessed using the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). A chemiluminescence immunoassay was used to investigate hormone profiles of the two groups, which were then compared and analyzed. The relation between the hormone levels and SANS and SAPS scores of the study group and controls was examined. RESULTS: There were statistically significantly higher levels of serum DHEA-S (p=0.002) in the study group than in the control group. No statistically significant difference was determined between the groups regarding serum testosterone and cortisol levels. A positive correlation was determined between the study groups' SANS scores and DHEA-S levels (p=0.012, r=0.440). CONCLUSION: DHEA-S might be a potential biologic marker for schizophrenia because there is evidence of an association between DHEA-S and the pathophysiology of schizophrenia. However, further research with greater patient numbers is required to verify these findings.

Inter-rater agreement of the Turkish version of the Neurobehavioral Rating Scale-Revised form.

OBJECTIVES: This study aims to adapt the Neurobehavioral Rating Scale-revised form (NBRS-R) for Turkish traumatic brain injury (TBI) patients and to investigate the inter-rater agreement of the Turkish revised scale. PATIENTS AND METHODS: A total of 45 patients (36 males, 9 females; mean age 31.1±13.0 years; range 18 to 60 years) with TBI were included in this study between September 2013 and August 2014. A semi-structured interview was set up for Turkish patients using a multidisciplinary approach (physiatrist, psychiatrist, neurologist and psychologist) with the participation of four rehabilitation centers. Questions were prepared for each of the 29 items, based on the recommendations of the original NBRS-R form. Four different interviewers from the four centers applied this form to a total of 45 TBI patients. RESULTS: The items evaluated by intra-class correlation coefficient showed satisfactory stability and the reliability of the items ranged from moderate to very good. CONCLUSION: The NBRS-R form can be suggested to provide a reliable and easily reproducible evaluation method of neurobehavioral deficits in TBI patients who speak Turkish.

The Relationship between Symptom Severity and Low Vitamin D Levels in Patients with Schizophrenia.

BACKGROUND: In recent years, the relationship between schizophrenia and environmental factors has come into prominence. This study investigated the relationship between vitamin D levels and the positive and negative symptoms of schizophrenia by comparing vitamin D levels between patients with schizophrenia and a healthy control group. METHODS: The study included 80 patients diagnosed with schizophrenia and 74 age- and sex-matched controls. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to evaluate symptom severity. The 25-hydroxyvitamin D (25OHD) levels of all subjects both patients and healthy controls were analyzed in relation to measurements of symptom severity. RESULTS: There were no significant differences between the groups in terms of age, sex, or physical activity. Their mean 25OHD levels were also similar (23.46±13.98ng/mL for the patient group and 23.69±9.61ng/mL for the control group). But when patients with schizophrenia were grouped based on their vitamin D levels, the results indicated a statistically significant differences between their vitamin D levels and their total SANS, affective flattening, and total SAPS, bizarre behavior and positive formal thought disorder scores (p = 0.019, p = 0.004, p = 0.015, p = 0.009 and p = 0.019, respectively). There is a negative correlation between 25OHD levels and SANS total points (r = -0.232, p = 0.038); a negative correlation for attention points (r = -0.227, p = 0.044) and negative correlation with positive formal thoughts (r = -0.257, p = 0.021). CONCLUSION: The results of this study show a relationship between lower levels of vitamin D and the occurrence of positive and negative symptoms, along with increased severity of symptoms at lower levels of vitamin D, suggesting that treatment for schizophrenia should include assessment of patients' vitamin D levels. We recommend that patients with schizophrenia should be assessed with regard to their vitamin D levels.

The Effect of Antipsychotics on Bone Mineral Density and Sex Hormones in Male Patients with Schizophrenia.

BACKGROUND: The aim of this study was to compare the bone mineral density (BMD) of male schizophrenia patients with those of healthy controls in order to determine the relationship between BMD and hormonal changes. SUBJECTS AND METHODS: The study sample included male outpatients between 18 and 55 years old, diagnosed with schizophrenia who had used prolactin-raising antipsychotics (n=23) and prolactin-sparing antipsychotics (n=19) for at least twelve months, along with an age - matched healthy control group. A socio-demographic form was administered, BMD and T-score measurements were performed with a DEXA test, and hormone levels were measured with commercial test kits. RESULTS: The prolactin levels of the prolactin-raising group (PRG) were significantly higher than those of the healthy control group (CG) and the prolactin-sparing group (PSG). While prolactin levels were normal in the CG, hyperprolactinemia was found in 15.8% (n=3) of patients in the PSG and 65.2% (n=15) of subjects in the PRG. Estradiol levels for the PRG and PSG were similar but significantly lower than those of the CG. There was a statistically significant difference between the PRG, PSG and CG in terms of their L1-4 total actual bone density and T-scores. BMD and T-scores were lower for the PRG in comparison with the PSG and CG, and were consistent with osteopenia. Although not observed for every tested region, a negative correlation was found between age, duration of therapy, duration of illness, and T-scores. A positive correlation was found between subjects BMI and T-scores. A consistent negative correlation was found between total testosterone and L1-4 total T-scores when corrected according to prolactin and estradiol. A linear regression analysis found significant relationships between age, BMI, duration of therapy, duration of illness, chlorpromazine equivalent dose, estradiol and testosterone affected T-scores for some regions. CONCLUSIONS: The long-term use of prolactin - raising antipsychotic medications as well as hyperprolactinemia and hypoestrogenism accelerate bone degradation.

The relationship between sex hormone profiles and symptoms of schizophrenia in men.

AIM: Recent studies have shown that sex hormones play a role in the development of schizophrenia and the severity of disease symptoms. However, study results have been inconsistent. This study compares the relationship between severity of disease symptoms and levels of estradiol, progesterone, testosterone, DHEA-S, prolactin and cortisol in male schizophrenia patients and a matched group of healthy controls. METHODS: The study sample included 38 men diagnosed with schizophrenia according to DSM-IV TR criteria, and matched by age with 38 healthy controls. All subjects were between 18 and 55years old, 22 of them had been treated with olanzapine and 16 with quetiapine. Their symptom severity was evaluated by administering the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). Hormone levels for schizophrenia patients and healthy controls were evaluated using a chemiluminescence immunoassay method. The hormone profiles of schizophrenia patients and healthy controls were compared statistically. We examined the relationship between subjects' and controls' hormone levels and their scores on the SANS and SAPS scales. RESULTS: This study found statistically significant elevated levels of serum DHEA-S, cortisol, and prolactin (p=0.012, p=0.009, and p=0.021 respectively), in schizophrenia patients as compared to a control group. Subjects' serum estradiol and progesterone levels (p=0.005 and p<0.001 respectively), were significantly lower than controls' levels. There was a positive correlation between subjects' SANS scores, estradiol (p=0.001) and progesterone levels (p=0.027). No relationship was found between subjects' hormone levels and their SAPS scores. CONCLUSION: There may be a relationship between progesterone, estradiol, cortisol and DHEA-S, and the pathophysiology of schizophrenia. These hormones can be used as biological markers for the disorder of schizophrenia. More studies with larger sample sizes are needed to confirm these findings.

The Effects of Prolactin-Raising and Prolactin-Sparing Antipsychotics on Prolactin Levels and Bone Mineral Density in Schizophrenic Patients.

INTRODUCTION: We aimed to investigate the effects of antipsychotics on prolactin levels in patients diagnosed with schizophrenia and the effects of hyperprolactinemia on bone mineral density (BMD) in patients on long-term antipsychotics. METHOD: In this study, we included eighty consecutive patients who were diagnosed with schizophrenia according to DSM-IV, had been using the same antipsychotic for the last ten months, and fulfilled the inclusion criteria. Data on sociodemographic characteristics of the patients were collected through an information sheet. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to rate positive and negative symptoms of the patients. In addition, their body mass indices (BMI) were calculated. Prolactin levels were measured through luminescence immune assay and BMD measurements were made at lumbar and femoral sites using dual-energy x-ray absorbtiometry. Haloperidol (n=20) and risperidone (n=20) were assigned to prolactin-raising antipsychotic group, and olanzapine (n=20) and quetiapine (n=20) were assigned to prolactin-sparing antipsychotic group for this study. The effects of antipsychotics on BMD were compared among these groups. RESULTS: Hyperprolactinemia was determined in 60% of haloperidol using patients, 90% of risperidone using patients, 25% of olanzapine using patients and 10% of quetiapine using patients. Mean prolactin levels were found to be significantly higher in prolactin-raising antipsychotic using group (p<0.001). There were no statistically significant differences in BMD values between the two groups, for the sites where the measurement was done. Lumbar spine and femoral neck T-scores and Z-scores in the prolactin-raising group significantly negatively correlated with the treatment durations and chlorpromazineequivalent doses (p<0.05). BMI and BMD values of both groups also displayed statistically significant positive correlations (p<0.05). CONCLUSION: The statistically significant differences in mean prolactin levels and numbers of patients with hyperprolactinemia between the treatment groups support the validity of classifying the antipsychotics as prolactin-raising and prolactin-sparing". The relationship of BMD with the treatment duration and doses in the prolactin-raising antipsychotic using group was deemed to be important, since it indicated that a decrease in BMD was to be expected in long-term antipsychotic treatment.

Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 10-week open-label study.

INTRODUCTION: Studies investigating the aripiprazole augmentation treatment of serotonin reuptake inhibitor (SRI)-resistant obsessive-compulsive disorder (OCD) are insufficient. The aim of the present pilot study was to investigate the efficacy and tolerability of flexible doses of aripiprazole as an augmenting agent in SRI-resistant OCD patients. METHODS: OCD patients who met the criteria of this study were followed up with flexible doses of aripiprazole augmentation over a 10-week period. Effectiveness of treatment was evaluated via the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales. At the end of the 10-week follow-up period, patients who showed an improvement of ≥30% for the Y-BOCS total score from baseline were considered responders. RESULTS: Thirty patients met the study inclusion criteria; three patients did not agree to participate, and four patients dropped out of the study. The differences between baseline and scores at 10 weeks for the parameters studied were as follows: Y-BOCS scores: 32.0±6.3-24.0±8.1 (Z=4.2, P<0.05); Y-BOCS compulsion subscore: 15.0±4.2-11.5±4.3 (Z=4.01, P<0.05); Y-BOCS obsession subscore: 17.0±2.6-12.4±4.0 (Z=4.1, P<0.05); and CGI-S scores: 4.8±0.8-3.1±1.2 (Z=3.9, P<0.05). Patients showed a significant improvement over the 10-week study period; however, only seven of 23 patients (30.4%) who completed the study met the criteria determined for treatment response. CONCLUSION: Despite the limited number of cases and open-label design of this study, results support the notion that adding aripiprazole to SRIs could be a valid strategy for treatment-resistant OCD patients.

Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain.

AIMS: Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain. METHODS: 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression. RESULTS: Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions. CONCLUSIONS: Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.