Investigation of Heschl's gyrus and planum temporale in patients with schizophrenia and bipolar disorder: a proton magnetic resonance spectroscopy study.

BACKGROUND: Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. METHODS: Thirty patients with schizophrenia (38.67±12.46years of age), 28 euthymic patients with bipolar I disorder (35.32±9.12years of age), and 30 age-, gender- and education-matched healthy controls were enrolled. Proton magnetic resonance spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschl's gyrus and planum temporale of superior temporal cortices. RESULTS: There were significant abnormalities in glutamate (Glu) (F(2,78)=8.52, p<0.0001), N-acetyl aspartate (tNAA) (F(2,81)=5.73, p=0.005), creatine (tCr) (F(2,83)=5.91, p=0.004) and inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. CONCLUSION: As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder.

Aripiprazole-induced rabbit syndrome: a case report.

Rabbit syndrome (RS) is a rare side effect of prolonged neuroleptic administration characterised by rapid, fine, rhythmic movements of the mouth along a vertical axis. Long-term exposure to the first generation neuroleptics has clearly been associated with RS, but little is known regarding the risk of RS because of the exposure to the newer atypical antipsychotics. Aripiprazole is a new dopaminergic agent and has been reported to be clinically useful as an antipsychotic drug with reduced extrapyramidal motor side effects. In addition, there are some case reports concerning extrapyramidal side effects, which include tardive dyskinesia, parkinsonism and RS associated with aripiprazole. We present the case of a patient who developed RS during treatment with aripiprazole. Potential mechanisms, including D2 receptor occupancy, low anticholinergic properties and dopamine hypersensitivity theory, are discussed. Although studies with aripiprazole have shown a low liability for extrapyramidal side effects, the present case emphasises the need for caution when treating patients with aripiprazole.

Lamotrigine-induced obsessional symptoms in a patient with bipolar II disorder: a case report.

Lamotrigine is an anticonvulsant that appears to have a mainly antidepressant effect and is indicated for the maintenance treatment of bipolar depression. Literature associated with obsessional symptoms related to lamotrigine treatment is limited. We report the emergence of obsessive symptoms during treatment with lamotrigine in a patient who subsequently experienced significant improvement after dose reduction and stopping of this medication. The obsessive symptoms associated with lamotrigine treatment were observed after the lamotrigine dose was increased to 100 mg/day. The possible mechanisms, including inhibition on the presynaptic release of glutamate and alteration of striatal dopamine uptake, are discussed. It is unclear why lamotrigine induces obsessions in some patients. Controlled studies are necessary to identify the population at risk for obsessionality in bipolar illness following treatment with lamotrigine and to investigate a possible dose-response relationship between obsessive symptoms and lamotrigine.

Importance of psychiatric intervention in intolerances in endoscopic procedures.

Despite the fact that pre-medication, in a number of different drug combinations, has been used for a long time in endoscopy units, and has been subject to extended clinical studies, it is still not possible to claim that it has attained an ideal state with regard to patient tolerance to endoscopy procedures. In this clinical study, we have investigated the effects of psychological intervention in addition to medication, which we used on patients with intolerance to endoscopy. Intolerance was very high in all endoscopic procedures (15.8% total). It was observed that average midazolam doses were significantly higher in intolerant than in tolerant patients. It was found that in patients who had received psychiatric intervention, the decrease in midazolam dose was statistically significant in a subsequent endoscopy procedure.

Thyroid abnormalities in lithium-treated patients with bipolar affective disorder.

The thyroid functions of 42 subjects with bipolar affective disorder receiving regular lithium therapy were analysed and their thyroid glands were examined by ultrasonography. Following the receipt of lithium therapy (duration 4-156 months), three subjects displayed subclinical hypothyroidism (7.1%), three subclinical hyperthyroidism (7.1%) and one hyperthyroidism (2.4%). Moreover, goitre was detected in 16 (38.1%) subjects. An increase in the conversion of free thyroxine (T4) to free tri-iodothyrosine (T3), which is an indication of mild thyroid dysfunction, was identified in 20 (47.6%) subjects, and was mostly seen in male subjects under 40 years of age and in those having weight gain. In conclusion, some thyroid dysfunctions were observed in the patients treated with lithium.

Erythrocyte superoxide dismutase and glutathione peroxidase activities, and malondialdehyde and reduced glutathione levels in schizophrenic patients.

There is abundant evidence that free radicals are involved in membrane pathology in the central nervous system and that they may play a role in neuropsychiatric disorders, including schizophrenia. In this study, we investigated erythrocyte superoxide dismutase and glutathione peroxidase activities as antioxidant enzymes, malondialdehydes as a sign of lipid peroxidation, and reduced glutathione levels in schizophrenic patients. Activities of superoxide dismutase and levels of malondialdehyde in erythrocytes were greater in all patients (n=48) and in patients with acute (n=16) and chronic schizophrenia (n=32) (p<0.001 for all patients and chronic patient group; p<0.05 for acute patient group). The activities of glutathione peroxidase were lower in patients (p<0.05 for all patients and acute patient group; p=0.051 for chronic patient group) compared with the control group. Mean erythrocyte reduced glutathione was lower in patients than in controls (p<0.05). In the patient group, erythrocyte superoxide dismutase activity was positively correlated with scales and duration of disease and erythrocyte malondialdehyde concentration. These data reveal that antioxidative defense mechanisms might be impaired in schizophrenic patients.

First-case postpartum psychoses in Eastern Turkey: a clinical case and follow-up study.

OBJECTIVE: The aim of this study was to investigate the clinicodemographic features and long-term course of postpartum psychosis (PPP). METHOD: A total of 64 in-patients with psychotic postpartum disorder, who were admitted for the first time to a psychiatry clinic, were reexamined retrospectively and then compared with 64 control patients. Follow-up investigation was carried out either by interviewing the patients personally or with the help of general practitioners (GPs). All patients were rediagnosed according to DSM-IV. RESULTS: The majority of PPP patients were young, married, primiparae, had a low educational level and were living in rural areas. The mean onset time of PPP after delivery was 3.62 weeks. More than 75% of the patients with PPP had further psychotic episodes during the follow-up period of 11 years; 42% of the puerperal cases were diagnosed as schizophrenia at the follow-up investigation, and 59.3% of the patients had confuso-oneiroid syndrome. CONCLUSION: These findings, unlike those of the Western studies, demonstrate that PPP is not uniform in different populations.