Investigation of the supportive therapy potential of propolis extract and Lactobacillus acidophilus LA-5 milk combination against breast cancer in mice.

Immunotherapy has been applied in cancer treatments for many years as an alternative treatment method to radiotherapy, chemotherapy. It is well known that immunotherapy could suppress tumor formation by modulating the immune system of the host. The aim of the study is to investigate supportive therapy potential of acidophilus milk (AS) and propolis extract (PE) in the mouse xenograft breast cancer model. For this purpose, firstly cytotoxic effect of PE was determined by MTT assay against 4 T1 mouse breast cancer cells. Apoptotic effect of PE analyzed by flow cytometry. The antibacterial activity of PE was determined by the 96-well microplate broth-dilution method on Lactobacillus acidophilus LA-5. Then, Balb/c mice were injected subcutaneously with 4 T1 cells (2x105 cells/mouse) and also mice were given daily oral gavage with PE (66 mg/kg/day) and/or acidophilus milk (108 CFU/mL/mouse/day) for 14 days. The Balb/c mice were weighed throughout the study, and the tumor sizes were measured by caliper at the 14th day. The proliferation of splenocytes which collected spleen from mice was measured by MTT. CD8 + T cell response was analyzed by flow cytometry and results were evaluated in comparison with control and tumor control groups. The IC50 value for PE on 4 T1 cells was determined as 129.25 ± 1.90 µg/mL. The apoptotic effect of PE at IC50 concentration was determined as 3.3% of cells to late-apoptosis, 4.3% of cells to pro-apoptosis and 2.5% of cells to necrosis. The MIC and MBC values for PE on L. acidophilus LA-5 were 5000 ppm. The treatment of PE, AS and the combination of PE and AS were inhibited the tumor volumes by 59.16%, 28.29% and 63.39%, respectively. Acidophilus milk and PE combination significantly enhanced the ConA-, LPS- and PHA-induced splenocyte proliferation (P < 0.05). The acidophilus milk and PE combination were also found to stimulate IFN- γ production. In conclusion, the best anti-tumor effect was obtained by the combination of acidophilus milk and propolis.

Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder.

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.

The validity and reliability of Turkish version of separation anxiety symptom inventory and adult separation anxiety questionnaire.

AIM: The aim of this study is to evaluate the validity and reliability of Separation Anxiety Symptoms Inventory (SASI) that assess childhood separation anxiety retrospectively and Adult Separation Anxiety Questionnaire (ASA). METHOD: The study sample included a group of 410 participants comprised of 282 adult psychiatric outpatients with anxiety and/or major depressive disorders according to DSM-IV criteria and 128 nonpsychiatric control subjects. The presence of psychiatric disorders was determined by using the M.I.N.I. (Mini International Neuropsychiatric Interview). Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), Separation Anxiety Symptoms Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA), Panic Disorder Severity Scale (PDSS), "Sensitivity to Separations" subscale of Panic Agorapfobic Spectrum Scale (PAS-SR), Anxiety Sensitivity Index (ASI) were also given. FINDINGS: The validity assessments of the instruments revealed that SASI and ASA discriminated the psychiatric patients from control subjects. Both instruments displayed high correlation with SCI-SAS and PAS-SR, a moderate correlation with ASI and PDSS. Factor structure assessments revealed the existence of 3 factor for SASI and 5 factor for ASA. Both SASI and ASA has a high level of internal consistency (Cronbach alfa coefficients are 0.89 and 0.93 respectively) and their test-retest reliability is fairly good. RESULTS: Turkish versions of SASI and ASA were found to be valid and reliable. Results indicate that those instruments can be used in clinical studies for surveying adult separation anxiety disorder and determining its severity.

History of suffocation, state-trait anxiety, and anxiety sensitivity in predicting 35% carbon dioxide-induced panic.

The aim of this study was to examine the effects of history of suffocation, state-trait anxiety, and anxiety sensitivity on response to a 35% carbon dioxide (CO2) challenge in panic disorder patients, their healthy first-degree relatives and healthy comparisons. Thirty-two patients with panic disorder, 32 first-degree relatives, and 34 healthy volunteers underwent the 35% CO2 challenge. We assessed baseline anxiety with the Anxiety Sensitivity Index (ASI) and State-Trait Anxiety Inventory (STAI1), and panic symptoms with the Panic Symptom List (PSL III-R). A history of suffocation was associated with greater risk of CO2 reactivity in the combined sample. Patients had more anxiety sensitivity and state and trait anxiety than relatives and healthy comparisons; the difference between relatives and healthy comparisons was not significant. In female patients, trait anxiety predicted CO2-induced panic. Having a CO2-sensitive panic disorder patient as a first-degree relative did not predict CO2-induced panic in a healthy relative. History of suffocation may be an important predictor of CO2-induced panic. Trait anxiety may have a gender-specific relation to CO2 reactivity.

Combination of pharmacotherapy with electroconvulsive therapy in prevention of depressive relapse: a pilot controlled trial.

OBJECTIVE: Relapse rates after electroconvulsive therapy (ECT) remain high with standard treatments. We aimed to test the efficacy of an early administered continuation pharmacotherapy (c-pharm early) strategy in prevention of post-ECT relapse. METHOD: A 20-week, randomized, double-blind, placebo-controlled trial. Patients aged 18 to 65 years diagnosed with Diagnostic and Statistical Manual of Mental Disorders major depressive disorder, with or without psychotic features, with initial Montgomery-Asberg Depression Rating Scale scores higher than 22, underwent 8 bilateral ECT sessions (2 per week). Randomization to c-pharm early, c-pharm late, and placebo groups in 2:2:1, respectively, was performed at the completion of the fourth ECT session. After randomization, subjects in the c-pharm early group were given sertraline at 150 mg/d. Subjects in the c-pharm late group were first given placebo, which was substituted with sertraline at 150 mg/d at the completion of the eight ECT. Relapse was defined as a Montgomery-Asberg Depression Rating Scale score of 16 or higher. RESULTS: Seventy-three percent of the patients responded to the given treatment. The relapse rates were 12.5% in the c-pharm early group, 28% in the c-pharm late group, and 67% in the placebo group (P = 0.09). The c-pharm early strategy resulted in significantly lower relapse rates and longer well time compared with the placebo (P = 0.04). When the trend with the initiation of the c-pharm intervention was investigated in the 3 groups with equally spaced trend weights, the time of initiation was found to have a significant effect on the probability of the remaining well (P = 0.03). CONCLUSIONS: Comparative efficacy of c-pharm early and late strategies in providing improved protection against post-ECT relapse of major depressive disorder needs to be further explored.

[Character and temperament dimensions of patients with temporomandibular disorder]. / Temporomandibuler bozuklugu olan hastalarda mizaç ve karakter boyutlari.

OBJECTIVE: The nature of the relationship between personality and temporomandibular disorder is an important, but still unexplored question. The objective of this study was to assess the personality profile of a sample of patients with temporomandibular disorder using the Temperament and Character Inventory (TCI). METHOD: The study included 81 patients [17 male (21%) and 64 female (79%)] with temporomandibular disorder and 80 healthy control subjects [15 male (18.75%) and 65 female (81.25%)]. A Turkish version of TCI was used for personality self-assessment. The data were evaluated with multivariate analyses of variance. RESULTS: Multivariate analyses of variance showed that the temperamental dimension, novelty seeking (F= 8.61, P= 0.004), was associated with temporomandibular disorder. Higher novelty seeking is thought to be linked to higher impulsiveness, exploratory excitability, and disorderliness. Also, there were significant differences between patients and healthy subjects on fatigability, purposefulness, compassion, and principled subscales of TCI. Gender differences were also found for different temperament and character dimensions. Women scored significantly higher on the self-directedness dimension, whereas male patients with temporomandibular disorder had significantly higher scores on the temperamental dimension of harm avoidance and its sub-dimension, shyness. CONCLUSION: Our study offers clinical evidence of the relationship between temporomandibular disorder and the personality profile of a high level of novelty seeking, which is considered to be associated with cluster B personality disorders. Assessing personality in patients with temporomandibular disorder should be considered while implementing treatment.

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge.

PURPOSE: We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV. METHODS: Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine. RESULTS: The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment. CONCLUSIONS: Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.

Panic disorder subtypes: further clinical differences.

Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace = 0.95, F (5, 118)(=)2.48, P = .036]. Patients in RS group had higher mean total scores on the ASI (F = 5.00, df = 1, P = .027) and PAS-SR (F = 11.23, df = 1, P = .001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P = .048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD.

[A new approach to the treatment of delirium: atypical antipsychotics]. / Deliryum Tedavisinde Yeni Bir Yaklasim: Atipik Antipsikotikler.

Delirium is a common neuropsychiatric syndrome that involves a number of symptoms including diffuse cognitive impairment, delusions, hallucinations, mood lability and disturbances in the sleep-wake cycle. It occurs in 10-30% of hospitalized medically ill patients. Delirium is also associated with a prolonged hospital stay and increased functional decline and morbidity and mortality rates, particularly if it is unrecognized and untreated. Management of the symptoms of delirium involves non-pharmacological and pharmacological interventions. Until recently, typical antipsychotics and benzodiazepines were commonly used in the pharmacological treatment of delirium. The extrapyramidal and anticholinergic side effects of typical antipsychotics and the negative effects of benzodiazepines on cognitive functions limit their use in delirium patients, who are generally old and who have other medical problems. Atypical antipsychotics have been shown to be effective in the treatment of psychotic symptoms. Although there are a number of studies showing their efficacy, most studies have some limitations such as small sample size and absence of control groups. Upon reviewing the studies of the treatment of delirium with atypical antipsychotics, it has been observed that the efficacy and safety of risperidone and olanzapine were shown in randomized trials, and the efficacy and safety of quetiapine were shown in case reports and retrospective studies, and it was shown that the side effect over the QT interval limits the use of ziprasidone in delirium treatment. Suggestions were made in the light of the literature on the use of atypical antipsychotics in the treatment of delirium.

[Panic-agoraphobic spectrum]. / Panik-Agorafobi Spektrumu Kavrami.

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.

Panic Disorder Severity Scale: reliability and validity of the Turkish version.

We assessed the reliability and validity of the Turkish version of the seven-item Panic Disorder Severity Scale (PDSS). We recruited 174 subjects, including 104 with current DSM-IV panic disorder with (n=76) or without(n=28)agoraphobia, 14 with a major depressive episode, 24 with a non-panic anxiety disorder, and 32 healthy controls. Assessment instruments were Panic Disorder Severity Scale, Panic and Agoraphobia Scale, both the observer-rated (P&Ao) and self-rating (P& Asr); Clinical Global Impression Scale (CGI); Hamilton Anxiety Scale, and Beck Depression Inventory. We repeated the measures for a group of panic disorder patients (n = 51) after 4 weeks to assess test-retest reliability. The internal consistency (Cronbach's alpha) of the PDSS was .92-94. The inter-rater correlation coefficient was .79. The test-retest correlation coefficient after 4 weeks was .63. In discriminant validity analyses, the highest correlation for PDSS was with P&Ao, P&Asr (r=.87 and.87, respectively) and CGI (r=.76) and the lowest with Beck Depression Inventory (r=.29). The cut-off point was six/seven, associated with high sensitivity (99%) and specificity (98%). This study confirmed the objectivity, reliability and validity of the Turkish version of the PDSS.