Prevalence and Sociodemographic Determinants of Substance Use in Turkey.

BACKGROUND: Substance use disorder is a serious public health problem. It is essential to know who is prone to substance use in order to adopt appropriate measures. OBJECTIVES: This study aims to determine the use prevalence ratios of substance use (tobacco, alcohol, cannabis, cocaine, synthetic cannabinoids, ecstasy, and others) in a large-scale sample of a general population. It also intends to examine related sociodemographic factors. METHODS: This study is based on a cross-sectional survey conducted with a nationally representative sample of 24,494 individuals in face-to-face interviews conducted by a trained team of 125 clinical psychologists. RESULTS: Lifetime prevalence of single substance use and polysubstance use are 4.5 and 2.6%, respectively (nicotine and alcohol excluded). Age, gender, education level, and marital status are important sociodemographic determinants for other substance use. Similarly, smoking and alcohol consumption are important determinants for other substance use. The multinomial regression analysis results showed that compared with adults aged 39 years and older, early-emerging adults (aged 18-23 years), late-emerging adults (aged 24-29 years), and young adults (aged 30-39 years) are more likely to turn to single substance use and polysubstance use. CONCLUSION: Tobacco, alcohol, and other substance use are serious health concerns in Turkey. Sociodemographic status is an important determinant of several aspects of tobacco, alcohol, and other substance use and, therefore, should be examined thoroughly to be able to develop effective protective and preventive strategies.

Psychological factors associated with smoking and quitting: addiction map of Turkey study.

BACKGROUND: Smoking is the most important modifiable factor in increased morbidity and premature mortality. This study aims to examine the psychological factors associated with smoking and quitting in a broad, nationally representative sample. PARTICIPANTS AND METHODS: The sample included a total of 24.494 adult individuals. Participants were divided into three groups as smokers, non-smokers, and "ex-smokers" who had stopped smoking since at least last one year. For the current smokers, cigarettes per day also noted. Brief Symptom Inventory, Toronto Alexithymia Scale (TAS), Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Experiences in Close Relationships-Revised Scales were used. RESULTS: 43.6% (n=10,672) of the participants were smokers; 5.7% (1386) were ex-smokers; 50.7% (n=12,414) were non-smokers. A higher number of daily smoked cigarettes was related to all subscales of Brief Symptom Inventory, TAS - Difficulty in Recognition of emotions, TAS - Difficulty in Expressing Emotions, Positive Affect Score, Negative Affect Score, Avoidance and Anxious Attachment scores (p<0.05). Externally oriented thinking is found to be significantly higher among ex-smokers than current smokers and non-smokers (p<0.05). CONCLUSION: The results of the present study indicate that smokers have more psychopathological characteristics in the psychometric evaluation, whereas ex-smokers are found to have similar scores to non-smokers. The higher percentage of externally oriented-thinking style in ex-smokers may suggest that this alexithymic characteristic can help the individual to deal with psychological addiction throughout quitting. On the other hand this result could also be related that stopping smoking leads to greater externally orientated thinking and other changes in psychological characteristics.

Sleep related eating disorder: Importance of prebariatric evaluation-A case report.

Sleep-related eating disorder (SRED) is a parasomnia characterised by recurrent episodes of eating after arousal from sleep, occurring in an unconscious and involuntary manner. It has been reported mainly in association with the use of psychotropic medications. This case report is of a patient diagnosed with a sleep-related eating disorder associated with amnesia in the postoperative period following bariatric surgery. Such eating episodes without awareness in postoperative period might have devastating results by disturbing compliance with suggested eating behaviours. Although it is a rare condition, SRED should be screened for among bariatric surgery candidates, and those affected should be directed for the appropriate treatment. Also whether SRED should be considered a contraindications to bariatric should be considered.

Neural Network Based Response Prediction of rTMS in Major Depressive Disorder Using QEEG Cordance.

OBJECTIVE: The combination of repetitive transcranial magnetic stimulation (rTMS), a non-pharmacological form of therapy for treating major depressive disorder (MDD), and electroencephalogram (EEG) is a valuable tool for investigating the functional connectivity in the brain. This study aims to explore whether pre-treating frontal quantitative EEG (QEEG) cordance is associated with response to rTMS treatment among MDD patients by using an artificial intelligence approach, artificial neural network (ANN). METHODS: The artificial neural network using pre-treatment cordance of frontal QEEG classification was carried out to identify responder or non-responder to rTMS treatment among 55 MDD subjects. The classification performance was evaluated using k-fold cross-validation. RESULTS: The ANN classification identified responders to rTMS treatment with a sensitivity of 93.33%, and its overall accuracy reached to 89.09%. Area under Receiver Operating Characteristic (ROC) curve (AUC) value for responder detection using 6, 8 and 10 fold cross validation were 0.917, 0.823 and 0.894 respectively. CONCLUSION: Potential utility of ANN approach method can be used as a clinical tool in administering rTMS therapy to a targeted group of subjects suffering from MDD. This methodology is more potentially useful to the clinician as prediction is possible using EEG data collected before this treatment process is initiated. It is worth using feature selection algorithms to raise the sensitivity and accuracy values.

The Phenomenology of Delusions in a Patient with Disorders of Sex Development.

Abnormal development of the external and internal genital organs and male pseudohermaphrodite-type disorders of sex development is one of the conditions that creates problem in determination of gender. In this case report, our aim is to discuss how disorders with psychotic symptoms may affect different cultural life styles, circumstances, experience, delusion contents of identification and acceptance in a patient diagnosed with bipolar affective disorder, and with male-pseudohermaphroditism during adulthood.

Sertraline Induced Galactorrhea.

There is limited literature reporting galactorrhea with antidepressants, including selective serotonin reuptake inhibitors. In this case report, a patient with adjustment disorder who developed galactorrhea with sertraline was presented.

Therapeutic drug monitoring: perspectives of psychiatrists in Turkey.

OBJECTIVES: Although the medical and economic implications of therapeutic drug monitoring have been intensely discussed over the past years, little is known about the experiences and attitudes of psychiatrists in their clinical practice. The aim of this study was to investigate psychiatrists' daily practice with therapeutic drug monitoring in Turkey. METHODS: A nation-wide cross-sectional survey among adult and child psychiatry specialist psychiatrists in Turkey was conducted. RESULTS: We found that 98.4% (n = 380) of the study participants used TDM in clinical practice and 1.6% (n = 6) did not. However, TDM use is limited to mood stabilizers (lithium 96.3%, valproate 97.6%) to a great extent. Only a small number of psychiatrists perform TDM for other psychotropic drugs, e.g., clozapine 2.4%, tricyclic antidepressants 1.3%, benzodiazepines 1.1%, and selective serotonin reuptake inhibitors 0,8%. CONCLUSIONS: Most of the psychiatrists in Turkey have a positive attitude toward use of therapeutic drug monitoring although there is also a considerable difficulty to reach services for the therapeutic drug monitoring of psychotropics other than mood stabilizers.

EEG power, cordance and coherence differences between unipolar and bipolar depression.

INTRODUCTION: Understanding the biological underpinnings of unipolar (UD) and bipolar depression (BD) is vital for avoiding inappropriate treatment through the misdiagnosis of bipolar patients in their first depressive episode. One plausible way to distinguish between UD and BD is to compare EEG brain dynamics to identify potential neurophysiological biomarkers. Here we aimed to test group differences in EEG power, cordance and coherence values between UD and BD. METHODS: Twenty-five bipolar and 56 unipolar depression patients were recruited. Sociodemographic and clinical variables were collected in addition to resting state EEG. Data was analyzed with multivariate and repeated analyses of variance where parametric assumptions were met. RESULTS: Accordingly, we did not find any differences in the EEG absolute power and frontal asymmetry indexes between UD and BD. Regarding cordance, significant group differences were observed in the right theta cordance values (p=0.031). Regarding coherence, BD patients (as compared to UD) exhibited greater central-temporal theta (p=0.003), and parietal-temporal alpha (p=0.007) and theta (p=0.001) coherence. Lastly, less alpha coherence in BD was present at right frontal-central (p=0.007) and central inter-hemispheric (p=0.019) regions. CONCLUSIONS: Our results demonstrate that EEG cordance and coherence values have potential to discriminate between UD and BD. The loss of temporal synchronization in the frontal interhemispheric and right sided frontolimbic neuronal networks may be a unique feature that distinguishes between BD and UD.

Decreased mean platelet volume in panic disorder.

AIM: The relationship between psychological stress and platelet activation has been widely studied. It is well known that platelets may reflect certain biochemical changes that occur in the brain when different mental conditions occur. Platelet 5-hydroxytryptamine (5-HT) is also extensively studied in psychiatry. The mean platelet volume (MPV), the accurate measure of platelet size, has been considered a marker and determinant of platelet function. The aim of the present study was to search for any probable difference in the MPV of subjects with panic disorder (PD). METHODS: A total of 37 drug-free subjects, aged 18 to 65 years, diagnosed with PD, with or without agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria and 45 healthy control subjects were included in the study. Platelet count and MPV were measured and recorded for each subject. RESULTS: There were no statistically significant differences between groups in terms of female/male ratio, age, or body mass index between the PD group and control group (P=0.91, P=0.82, and P=0.93, respectively). The MPV was found to be significantly lower in the PD group compared with the control group (8.8±0.9 fL vs 9.2±0.8 fL; P=0.02). All the participants had MPV values in the standard range of 6.9-10.8 fL. CONCLUSION: We concluded that abnormalities of the 5-HT1A receptor function in the central nervous system of subjects with a diagnosis of PD are also mirrored in as an alteration in platelet activity. Measurements of platelet activity may be used as a tool for neuropsychiatric and psychopharmacological research and for studying how certain mental diseases and medications affect the central nervous system.

Effect of valproate on the plasma concentrations of aripiprazole in bipolar patients.

OBJECTIVE: There is very limited documentation available on the effects of valproate co-medication on the pharmacokinetics of aripiprazole in a naturalistic setting. The aim of the present study was to investigate the effect of co-medication with valproate on serum concentrations of aripiprazole in bipolar disorder patients in a clinical setting. METHOD: Plasma samples of bipolar disorder patients (n = 69) on a stable dose of aripiprazole 20 mg/day were analyzed by a liquid chromatography-mass spectrometry method in a routine therapeutic drug monitoring setting. Therapeutic drug monitoring was done for the entire study group before and after valproate co-administration. RESULTS: We observed a statistically significant difference between the aripiprazole monotherapy and aripiprazole-valproate combination with respect to total aripiprazole plasma levels (p < 0.01). However, no statistically significant differences were noted in aripiprazole levels between the first week and the second week of valproate co-administration. CONCLUSION: In conclusion, concurrent treatment with valproate resulted in changes in the total aripiprazole plasma levels by 23%. But a lower total aripiprazole concentration during co-medication with valproate, caused by protein binding displacement, is reported being clinically insignificant in previous studies. The results from these studies are important in order to clarify clinical safety and efficacy.

Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients.

BACKGROUND: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. "Valproate" is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment. AIM: The purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients. METHODS: In an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia. RESULTS: Valproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group. CONCLUSION: The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered.

Transcranial magnetic stimulation during pregnancy.

The aim of the present study was to assess the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in pregnant patients with depression. Thirty depressed pregnant patients received rTMS over the left prefrontal cortex for 6 days in a week, from Monday to Saturday for 3 weeks. The rTMS intensity was set at 100% of the motor threshold. A 25-Hz stimulation with a duration of 2 s was delivered 20 times with 30-s intervals. A session comprised 1,000 magnetic pulses. Depression was rated using the 17-item Hamilton depression rating scale (HAMD) before and after treatment. Response was defined as a 50% reduction of the HAMD score. Patients with HAMD scores less than 8 were considered to be in remission. The mean HAMD score for the study group decreased from 26.77 ± 5.58 to 13.03 ± 6.93 (p < 0.001) after 18 sessions of rTMS. After the treatment period, 41.4% of the study group demonstrated significant mood improvements as indexed by a reduction of more than 50% on the HAMD score. In addition, 20.7% attained remission (HAMD score < 8), 34.5% achieved a partial response, and 3.4% had worsening in HAMD scores at the end of treatment. Treatment was well tolerated, and no significant adverse effects were reported. rTMS was well tolerated and found to be statistically and clinically effective in pregnant patients with treatment-resistant depression. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression in pregnancy.

Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia.

OBJECTIVE: Patients with schizophrenia often experience comorbid obsessive-compulsive symptoms. Within these patients, a significant subgroup developed secondary obsessive-compulsive symptoms during treatment with clozapine. METHOD: In this paper, we report on four cases in which adjunctive therapy with aripiprazole was tested to alleviate obsessive-compulsive symptoms in schizophrenia. RESULTS: All four patients had a significant improvement in obsessive-compulsive symptoms. The combination of clozapine and aripiprazole was well tolerated. CONCLUSION: This case series demonstrates the clinical efficacy of aripiprazole adjunctive therapy with clozapine in schizophrenic patients with comorbid obsessive-compulsive symptoms. Larger-sampled and controlled studies are required in order to test and confirm these observations.

Transcranial magnetic stimulation for treating depression in elderly patients.

PURPOSE: The aim of the study reported here was to examine the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in elderly patients with depression. PATIENTS AND METHODS: Sixty-five depressed elderly patients received rTMS over their left prefrontal cortex for 6 days per week, from Monday to Saturday, for 3 weeks. The rTMS intensity was set at 100% of the motor threshold and 25 Hz stimulation with a duration of 2 seconds and was delivered 20 times at 30-second intervals. A full course comprised an average of 1000 magnetic pulses. Depression was rated using the Hamilton Depression Rating Scale (HAMD) before and after treatment. Response was defined as a 50% reduction in HAMD score. Patients with HAMD scores < 8 were considered to be in remission. RESULTS: The mean HAMD score for the study group decreased from 21.94 ± 5.12 before treatment to 11.28 ± 4.56 after rTMS (P < 0.001). Following the treatment period, 58.46% of the study group demonstrated significant mood improvement, as indexed by a reduction of more than 50% on the HAMD score. Nineteen of these 38 patients attained remission (HAMD score < 8), while 41.54% of all study patients achieved a partial response. None of the patients had a worsened HAMD score at the end of the treatment. Treatment was generally well tolerated and no serious adverse effects were reported. CONCLUSION: In this study, rTMS was found to be a safe, well-tolerated treatment, and a useful adjunctive treatment to medications in elderly treatment-resistant depressed patients. This study contributes to the existing evidence on the antidepressant effect of rTMS in the treatment of depression in patients over 60 years of age.