The Effects of Prolactin-Raising and Prolactin-Sparing Antipsychotics on Prolactin Levels and Bone Mineral Density in Schizophrenic Patients.

INTRODUCTION: We aimed to investigate the effects of antipsychotics on prolactin levels in patients diagnosed with schizophrenia and the effects of hyperprolactinemia on bone mineral density (BMD) in patients on long-term antipsychotics. METHOD: In this study, we included eighty consecutive patients who were diagnosed with schizophrenia according to DSM-IV, had been using the same antipsychotic for the last ten months, and fulfilled the inclusion criteria. Data on sociodemographic characteristics of the patients were collected through an information sheet. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to rate positive and negative symptoms of the patients. In addition, their body mass indices (BMI) were calculated. Prolactin levels were measured through luminescence immune assay and BMD measurements were made at lumbar and femoral sites using dual-energy x-ray absorbtiometry. Haloperidol (n=20) and risperidone (n=20) were assigned to prolactin-raising antipsychotic group, and olanzapine (n=20) and quetiapine (n=20) were assigned to prolactin-sparing antipsychotic group for this study. The effects of antipsychotics on BMD were compared among these groups. RESULTS: Hyperprolactinemia was determined in 60% of haloperidol using patients, 90% of risperidone using patients, 25% of olanzapine using patients and 10% of quetiapine using patients. Mean prolactin levels were found to be significantly higher in prolactin-raising antipsychotic using group (p<0.001). There were no statistically significant differences in BMD values between the two groups, for the sites where the measurement was done. Lumbar spine and femoral neck T-scores and Z-scores in the prolactin-raising group significantly negatively correlated with the treatment durations and chlorpromazineequivalent doses (p<0.05). BMI and BMD values of both groups also displayed statistically significant positive correlations (p<0.05). CONCLUSION: The statistically significant differences in mean prolactin levels and numbers of patients with hyperprolactinemia between the treatment groups support the validity of classifying the antipsychotics as prolactin-raising and prolactin-sparing". The relationship of BMD with the treatment duration and doses in the prolactin-raising antipsychotic using group was deemed to be important, since it indicated that a decrease in BMD was to be expected in long-term antipsychotic treatment.

Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain.

AIMS: Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain. METHODS: 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression. RESULTS: Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions. CONCLUSIONS: Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.

IL-6 levels decrease with SSRI treatment in patients with major depression.

OBJECTIVE: Some evidence indicates that an immune response with an increased production of proinflammatory cytokines often accompanies major depression. The objective of this study was to examine the serum levels of IL-6 in patients with major depression and the changes occurring in IL-6 levels during treatment with selective serotonin reuptake inhibitors (SSRI). METHOD: Twenty-three patients with a DSM-IV diagnosis of major depressive disorder and 23 healthy matched controls were included in the study. The severity of depression was measured with the Hamilton rating scale for depression. Blood samples for IL-6 levels were obtained at baseline and at week 6 of treatment and IL-6 concentrations were evaluated using a solid phase sandwich enzyme immunoassay. All patients were treated with an SSRI. RESULTS: The IL-6 levels showed no statistically significant difference between the patients and the controls at baseline. However, IL-6 levels after treatment with SSRIs were significantly lower compared with the baseline IL-6 levels of both the patients and the controls. CONCLUSION: The results of this study suggest that proinflammatory cytokines show some changes during the course of treatment of major depression. These findings might also be considered as supporting the hypothesis of a modulatory role of antidepressants on the immune system.

[Mental disorders in the parents of bipolar patients]. / Bipolar Bozukluk Tanisi Konan Hastalarin Ebeveynlerinde Ruhsal Bozukluklar.

OBJECTIVE: It is well known that bipolar disorder has familial transmission. Studies indicate that first-degree relatives of bipolar patients also have higher incidences of other mental disorders than the general population. The aim of this study is to determine the prevalence of mental disorders in the parents of bipolar patients. METHOD: Parents of 35 probands who were treated for their bipolar disorders and 35 age and gender matched healthy subjects' parents were assessed by means of the Structured Clinical Interview for DSM IV (SCID-I), and a questionnaire for the parents. RESULTS: Past and current mental disorders were present in 27.1% of the parents of bipolar patients but in 14.2% of the parents of normal controls; the difference between the groups is statistically significant. The most prevalent mental disorder in both groups is major depressive disorder. The parents of bipolar patients were more likely to have a family history of mental disorder (44.2%) than the control group (12.8%). Parents who had a current or past mental disorder were more likely to have a family history of mental disease. Offspring of in-bred families had more bipolar siblings. Bipolar children of parents who had a family history of mental disorder tended to have an earlier age of onset. CONCLUSION: The findings of this study indicate that there is an increased prevalence of bipolar disorders and other mental disorders in the parents of bipolar patients when compared to the parents of healthy controls.

The psychiatric view of patients of aesthetic surgery: self-esteem, body image, and eating attitude.

The patient who presents for aesthetic surgery possesses various demands depending on the characteristic properties of the individual. Evaluation of self-esteem, body image and eating habits in patients of aesthetic surgery could help in understanding patients and their demands. We performed Rosenberg Scale Test for evaluation of self-esteem on 98 patients who presented for any kind of aesthetic surgery. Seventy-five patients who required no operation for body fat tissue were give body imaging scale and eating attitude scale tests. The results of the tests revealed an increase in the self-esteem of the patients, but it was not statistically significant. There was a minor disturbance in the body imaging scale without any statistical significance ( p > 0.05). The eating attitude of the patients indicated a disturbance with a ratio of 10% ( p < 0.01), and these patients were referred to psychiatrists. Even if patients of aesthetic surgery have no disorder in the perception of their body images, they reflect their aesthetic problems in their eating attitude; however they have no problem in the fat tissue distribution of their body. The aesthetic imperfection could impede the normal daily life of a patient and adaptation to the social life, and this defect is a health problem that should be solved as soon as possible.