Human leukocyte antigen DR1 in Japanese and Turkish patients with schizophrenia.

The main focus of this review has been to discuss the probable causes of the higher frequency of HLA DR1 antigen in patients with schizophrenia from Japan and Turkey, and also to see whether there was an impact of belonging to the Ural-Altaic language group. A general medline search on the terms HLA and schizophrenia was used as the method to determine HLA studies in patients with schizophrenia. Most of the findings were inconsistent regarding the increased or decreased frequencies of different Class I and II antigens. However, there were interesting results, which have been consistently repeated in several Japanese studies and in a Turkish study. HLA DR1 antigen was statistically significantly increased in Japanese and Turkish patients with schizophrenia. As Japanese and Turkish languages belong to the Ural-Altaic language group, HLA DR1 antigen might have a specific association with schizophrenia in Japanese and Turkish patients. Searching the frequency of HLA DR1 antigen in patients with schizophrenia in other members of Ural-Altaic language group is necessary to support this hypothesis. Other language groups (e.g. Indo-European) should be assessed as well.

Paternal and sibling incest: a case report.

A case is reported of a female victim of paternal incest, who had also been raped repeatedly by her elder brother for two years. A survey of the literature showed no other report of such a case from Turkey. This does not necessarily mean that the incidence of paternal and sibling incest does not happen, but may indicate that incestuous abuse is not reported or handled without making it known to legal authorities. The victim was first raped by her 16 year-old brother when she was 9 years old. He raped her repeatedly over a period of two years, until he left home. Her father began raping the victim when she was 13 year-old, leaving her pregnant at age 15. He took her to a doctor for a termination of pregnancy. The father continued abuse after the termination. The victim left home to marry a man. The father filed a lawsuit against the man for taking the victim away from home. More openness and awareness of incest in Turkey may encourage the victims to seek help from medical and legal authorities.

Low doses of clozapine may stabilize treatment-resistant bipolar patients.

Open, uncontrolled studies suggest clozapine can have mood-stabilizing effects in treatment-resistant bipolar disorder. Unfortunately, the side effect profile limits clozapine's use at high doses. We report a series of nine bipolar I disorder patients who improved on relatively low doses of clozapine add-on therapy (250 mg or lower). Retrospectively abstracted clinical data identified nine patients with bipolar I disorder, as defined by DSMIV criteria, treated with low-dose clozapine at inpatient and outpatient settings. Monthly symptom evaluations were collected prospectively using standard assessments. Symptoms of mania and mood lability improved in all patients. Three patients demonstrated striking mood stabilization and returned to previous levels of functioning; five patients evidenced moderate improvement in mood stabilization and functioning; and one patient showed a minimal response. Overall, clozapine did not have a significant antidepressant effect. The mean clozapine dose at the end of the study was 156.3 +/- 77.6 mg/day, and duration of treatment was 12 months. Residual side effects were mild. The symptomatic improvement in these prospectively evaluated patients is consistent with our clinical impression in the majority of patients with bipolar disorder taking clozapine.

Response to clozapine of rapid cycling versus non-cycling patients with a history of mania.

OBJECTIVE: Rapid cycling (RC) bipolar disorder (BD) patients often do not respond fully to mood-stabilizers. Atypical antipsychotics including clozapine may be good candidates as an alternative mood-stabilizer for these patients. METHODS: Twenty-eight treatment-resistant patients with either Bipolar Disorder Type I (n = 20), or Schizoaffective Disorder Bipolar Type (n = 8) received clozapine add-on therapy. Patients were followed for up to 1 year. Patients were seen monthly and assessed on a number of symptom domains. RESULTS: Fifteen of 28 patients met RC criteria. Differences between groups was non-significant for reported age of onset, age at study entry, past history of treatment or hospitalization, or diagnosis. However, significantly more women were RC. More than 80% of patients in either group showed at least some improvement over the 1-year study. Random regression analyses found the non-rapid cycling (NRC) group experienced significantly greater improvement than RC patients (p < 0.0001). CONCLUSIONS: Clozapine is more effective in NRC patients with a history of mania in comparison to patients with a recent history of RC.

Antioxidant enzyme activities and oxidative stress in affective disorders.

Recent data from several reports indicate that free radicals are involved in the biochemical mechanisms underlying neuropsychiatric disorders in human. The results of several reports suggest that lower antioxidant defences against lipid peroxidation exist in patients with depression and that there is a therapeutic benefit from antioxidant supplementation in unstable manic-depressive patients. We investigated the antioxidant enzyme status and the indices of oxidative stress and lipid peroxidation end products in erythrocytes from patients with affective disorder. For this purpose, we measured superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activities, as well as malondialdehyde (MDA) and nitric oxide (NO) levels in patients with affective disorders (n=30) in both pre- and post-treatment periods, and in a control group (n=21). CAT activities were significantly decreased in both pre-, and post-treatment periods in patients compared to the control group. GSH-Px activity in the pre-treatment period in the patients was significantly lower than both post-treatment patient and control groups. MDA levels were increased in both pre-, and post-treatment patient groups compared to the control group. NO level was lower in the pre-treatment patient group than in the control group. There were statistically significant correlations between SOD and MDA, and SOD and NO in the pre-treatment patient and control groups. Because the overall study sample was small, and the post-treatment patient group was even smaller, it can tentatively be suggested that the antioxidant system is impaired during a mood episode in patients with affective disorders, normalizing at the end of the episode.

Weight gain and improvement with quetiapine in bipolar I disorder: a case report.

Observations made with quetiapine (QUET) in this case give clues for some aspects of its use for patients with bipolar disorder. Weight gain (11 kg; 16.6% increase in 21 weeks) and improvement in manic symptoms occurred after QUET add-on to lithium (Li). Patient's mood improved after QUET add-on without causing extrapyramidal symptoms (EPS), while QUET was discontinued due to weight gain. Short-term QUET add-on to Li may help mood stabilization in bipolar I disorder. Weight changes must be observed carefully.

Gonadal hormones in schizophrenia and mood disorders.

There are gender-related differences in the prevalence, course and treatment response characteristics of schizophrenia and mood disorders. Gonadal steroids exert potent effects on mood, cognition and behavior, and there is little doubt that androgens are crucial for differentiating to each gender. Serum level of total testosterone, free testosterone, estradiol and sex hormone binding globulin was measured in 69 medication-free men with either schizophrenia (n=29) or bipolar I disorder, manic episode (n=18) or major depressive disorder (n=22). There was a statistically significant difference in free testosterone level between mania and schizophrenia groups (p<0.05). The higher free testosterone level in the mania group compared to the schizophrenia group found in this study supports further investigation of a potential difference in the hypothalamic-pituitary-gonadal axis between patients with schizophrenia and bipolar I disorder, manic.