Antidepressant-associated mania or hypomania: a comparison with personality and bipolarity features of bipolar I disorder.

BACKGROUND: Hypomania/mania during antidepressant treatment is often neglected by clinicians. There are no specific diagnostic criteria for hypomania and mania associated by antidepressant treatment in the bipolar spectrum. The aim of this study is to compare various characteristics of bipolar I disorder and antidepressant-associated mania. METHOD: In this study, 76 bipolar patients who met DSM-IV criteria for bipolar disorder-type I in remission from mania or depression (Group 1; n = 44) and patients with major depression in remission, who had mania associated by antidepressant treatment (Group 2; n = 32), were admitted. All patients were assessed using the SCID I, Bipolarity Index (BI) and a patient data form. First-degree relatives of all patients were evaluated using the Mood Disorder Questionnaire (MDQ). RESULTS: Sociodemographic features of both groups were similar. The rate of major depression in the relatives of Group 2 was significantly higher than in Group 1. The severity of manic symptoms in Group 2 was significantly lower than in Group 1. Those in Group 2 who were diagnosed with their first episode had atypical depressive features. First-degree relatives of patients in Group 1 had higher positive scores on the MDQ. A statistically significant difference was found between the two groups on all dimensions of the BI except family history. LIMITATIONS: This is a cross-sectional study with a relatively small number of subjects. There is no control group of major depressive patients who did not develop mania during antidepressive treatment. CONCLUSIONS: Our results suggest that antidepressant-associated hypomania/mania could be a different subgroup in the bipolar spectrum.

Aggression among male alcohol-dependent inpatients who smoke cigarettes.

The authors aimed to explore the relation between nicotine dependence and the severity of aggression among Turkish male alcohol-dependent inpatients who smoked cigarettes, as well as the effect of aggression in these groups. Participants were 126 male alcohol-dependent inpatients who were given the Structured Clinical Interview for DSM-IV, Substance Use Disorder Module (A. Corapcioglu, O. Aydemir, & M. Yildiz, 1999; M. B. First, R. L. Spitzer, & J. B. W. Williams, 1997), the Fagerstrom Test for Nicotine Dependence (K. O. Fagerstrom, 1978), and the Overt Aggression Scale (OAS; S. C. Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. Williams, 1986). The authors found differences between male alcohol-dependent inpatients with nicotine dependence (n = 94) and those with nondependence (n = 32) in OAS subtypes. The authors' findings showed that smoking cigarettes-an addiction frequently observed with alcoholism-was positively correlated with aggressive behaviors. The authors suggest that smoking cigarettes may cause aggression or aggression may cause smoking. Observing and evaluating how aggression and smoking cigarettes are associated with alcohol dependence may help relapse prevention and improve effectiveness of treatment interventions in alcoholism.

Role of family in alcohol and substance abuse.

Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. Accordingly, it is important to know the family structure and its role in the treatment process. This article covers a review of family systems separately in terms of alcoholism and substance abuse.

[A case of tianeptine abuse]. / Tiyaneptin Kötüye Kullanimi: Bir Olgu Sunumu.

Tianeptine is an antidepressant agent like the selective serotonin reuptake inhibitors (SSRIs). The anxiolytic efficacy of tianeptine is similar to that of tricyclic and tetracyclic antidepressants. Very few cases have been reported in connection with excessive consumption of tianeptine. Although it is not reconciled with results of many studies on excessive consumption of tianeptine, stimulant action has been specifically emphasized on some case reports of tianeptine abuse. These reports indicate that a tolerance is developed, there is a strong mode of feeling, and there are physical withdrawal symptoms if not taken again. Treatment with tianeptine can pose a risk for addicted patients in terms of high doses as well as tolerability. In this article, we report a 24-year-old patient who abused tianeptine for one year. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seeks a psychostimulant effect. The patient had a previous history of addiction to cannabis, opiates and cocaine. We concluded that the effect of tianeptine and its addiction risk at the patient who had a history of addiction to multiple substances, and spontaneously increased dose of tianeptine during the last one year up to 3000 mg per day at present. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional.