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Papers by memduha aydin

Journal of Psychosomatic Research

INTERNATIONAL CONGRESS of SCIENCE CULTURE and EDUCATION, 2019

Clozapine is an atypical antipsychotic with proven efficacy in treatment-resistant schizophrenia.... more Clozapine is an atypical antipsychotic with proven efficacy in treatment-resistant schizophrenia. However, some possible side effects of clozapine limit its use. Cardiomyopathy is a rare, but potentially fatal, side effect. Presently described is the diagnosis and treatment of a case of cardiomyopathy associated with clozapine use. The patient was 40 years old with a 17-year history of schizophrenia. Cardiomyopathy was diagnosed 15 months after the initiation of clozapine treatment. The presence of dilated cardiomyopathy and pleural effusion was confirmed with echocardiography. Cardiopulmonary arrest led to treatment in the intensive care unit. After discharge, amisulpride treatment was introduced. It is of great importance that these cardiovascular symptoms are not overlooked in the course of clozapine treatment. Early diagnosis and treatment play a crucial role, and complaints such as fever, shortness of breath, palpitations, and fatigue must be taken into account in patients rece...

Genel Tip Dergisi, 2020

Öz Amaç: Ortalama yaşam süresinin uzaması ile ülkemizde psikiyatri kliniklerinde yatan geriatrik ... more Öz Amaç: Ortalama yaşam süresinin uzaması ile ülkemizde psikiyatri kliniklerinde yatan geriatrik hastaların sayısının artması, tanılarının tespitini önemli hale getirmiştir. Geriatrik popülasyonda, psikiyatri servisinde yatarak tedavi gören hastaların tanı ve tedavilerine ilişkin bilgileri değerlendirmeyi amaçladık. Gereç ve Yöntem: Selçuk Üniversitesi Tıp Fakültesi'nde 2010-2017 yılları arasında yatmış olan 60 yaş ve üzeri(73 hastanın) sosyodemografik ve klinik özellikleri tıbbi kayıtlarla karşılaştırılmıştır. Bulgular: Hastaların ortalama yaşı 67.5±5.5 ve %56.9'u (n:41) kadınlardan oluşmaktaydı. Tanıları gözden geçirildiğinde %38.9'u (n:28) depresif dönem, %16.7'si, (n:12) anksiyete bozukluğu, %11.1'i (n:8) psikotik bozukluk, %15.3'ü (n:11) bipolar bozukluk depresif (n:3) ya da manik (n:8) dönem nedeniyle tedavi edilmişti, %19.5 (n:14) hastanın demans eş tanısı vardı.Hastaların psikiyatrik hastalıkların %19.4'ünde (n:14) hipertansiyon(HT) ve Diyabetes Mellitus (DM), %7.8'ine (n:6) tiroid işlev bozukluğu eşlik etmekteydi. Hastaların büyük çoğunluğu (%79.2 n:57) kısmi remisyonla taburcu edilmişti. Taburculuk tedavileri değerlendirildiğinde %38.9'u (n:28) antipsikotik ve antidepresan kombinasyonu, %23.6'sının (n:17) ise antidepresan monoterapisi ya da kombinasyonu ile taburcu edildiği saptandı. Sonuç: Depresyon ve anksiyete bozuklukları, ileri yaşlarda en sık görülen ruh sağlığı sorunlarından ikisidir ve araştırmamız bulguları da yazın ile uyumludur Ülkemizde geriatrik hasta grubunun tanımlanarak, tedavi politikalarının geliştirilmesi açısından büyük örneklemli izlem çalışmaları yapılması gerekmektedir.

Medicine Science | International Medical Journal, 2021

Bipolar disorder is characterized by recurrent mood episodes and its pathophysiology remains a my... more Bipolar disorder is characterized by recurrent mood episodes and its pathophysiology remains a mystery. Inflammation is thought to be core feature in pathophysiology of bipolar disorder. The aim of this study is to compare neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR) and mean platelet volume (MPV) as systemic inflammatory markers between different mood episodes in same patients and healthy controls, to evaluate whether these may serve as a possible trait or state biomarker of bipolar disorder. This retrospective study was performed on 127 patients and 98 healthy controls. Among the patients, only 27 presented euthymia, mania, and depression, 89 presented mania and euthymia, 47 presented mania and depression and 45 presented depression and euthymia at different times. This study indicated that NLR and MLR values in mania were higher than in euthymia of same patients (p=0.014, p=0.023). Additionally, we found that patients in mania had higher levels of MPV, NLR and MLR than controls (p=0.015, p=0.030, p=0.045). Our results support the association of bipolar disorder with systemic inflammation and suggest that NLR and MLR may be potential state biomarkers for in manic episodes.

Turkish Journal of Psychiatry, 2021

OBJECTIVE In this study, it was aimed to define the clinical characteristics, causes of death, di... more OBJECTIVE In this study, it was aimed to define the clinical characteristics, causes of death, disease and treatment of patients who died while being followed for severe mental illness. METHOD The study was carried out in ten community mental health centers from six provinces. The clinical characteristics, causes of death, course of the illness and treatment characteristics of the patients who had a death report from the date the community mental health centers were opened until the start date of the study were analyzed by retrospective file scanning method. RESULTS In an average of 52 months, files of 3715 patients were examined. There were death declarations for 106 patients. The diagnosis of most patients with death declarations was schizophrenia (78%), most of them were male (66%), mean age was 57, mean disease duration was 24 years. The rate of multiple antipsychotic medication use was 61%. The most common comorbidities were metabolic syndrome (36%), hypertension (22%), diabetes (18%) and chronic obstructive pulmonary disease (15%). The most frequently reported causes of death were cardiovascular diseases (39%), infectious diseases (14%) and cancer (11%). CONCLUSION Individuals with severe mental illness followed up in community mental health centers are mostly die due to preventable natural causes of death. Therefore, a sensitive approach should be taken to evaluate psychiatric and other medical conditions together. In our country, there is a need for natural follow-up studies investigating the average age of death and causes of death of individuals with severe mental illness.

The International Journal of Psychiatry in Medicine, 2020

Objective We aimed to evaluate the relationship between perceived social support, coping strategi... more Objective We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. Method The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. Results The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04–17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0...

Schizophrenia Bulletin Open, 2020

Clozapine (CLZ) is considered the most effective antipsychotic, but its use is associated with ne... more Clozapine (CLZ) is considered the most effective antipsychotic, but its use is associated with neutropenia (CIN) and agranulocytosis (CIA). Although the exact etiology of these hazardous side effects is unknown, 4 genetic polymorphisms have been implicated by genome-wide association studies (GWAS), mostly performed in North-Western Europeans. These polymorphisms are rs113332494 (HLA-DQB1), rs41549217 (HLA-B), and rs1546308/rs149104283 (SLCO1B3/7), several of which were not directly genotyped but imputed. To test whether these 4 single-nucleotide polymorphisms (SNPs) are associated with CIN/CIA in a Turkish population and in a more extensive group of Caucasians, we directly genotyped these polymorphisms using Taqman and Sanger sequencing and performed logistic regression. We divided our participants (234 CLZ-using participants of whom 31 CIN/CIA cases) into (1) North-Western European, (2) Turkish, (3) Caucasian (=1 + 2); and (4) a total group (Caucasian + other ethnicities). Rs113332...

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry, 2018

Öz Lityum, 1800'lü yılların basinda İṡveçli Arfvedson tarafından kesfedilmiş ve 1950'li yıllarda... more Öz Lityum, 1800'lü yılların basinda İṡveçli Arfvedson tarafından kesfedilmiş ve 1950'li yıllarda psikiyatri alanında kullanılmaya başlanmıştır. Yetişkinlerde bipolar tedavisinde ilk sırada gelen bir duygudurum düzenleyici ve altın standart bir tedavi ajanıdır. Ancak, klinik uygulamada bireyler arasında lityum tedavisine yanıt oranları hastaların farklı özellikleri nedeniyle oldukça değişken olup, hangi hastanın lityuma iyi yanıt vereceğini öngörmek çoğunlukla zordur. Lityum tedavi yanıtını öngörmede klinisyenler öncelikle klinik bir fenotipi tanımaya odaklanmış gibi durmaktadır. Bu yazıda lityum tedavi yanıtının yordayıcıları ile ilgili araştırmalar gözden geçirilerek; klinik, biyokimyasal, nörogörüntüleme ve genetik yordayıcılar olmak üzere dört başlık altında ele alınmıştır.

Genel Tip Dergisi, 2019

Öz Amaç: Obezite dünyanın her yerinde yaygın olarak rastlanan, mortalite ve morbiditeyi arttıran ... more Öz Amaç: Obezite dünyanın her yerinde yaygın olarak rastlanan, mortalite ve morbiditeyi arttıran ciddi bir halk sağlığı sorunudur. Bariatrik cerrahi ise son on yıl içerisinde giderek popüler hale gelen ve daha çok tercih edilmeye başlanan bir obezite tedavi yöntemidir. Bu çalışmanın amacı bariatrik cerrahi adayı olan obezite hastalarının psikiyatrik görüşme yapılarak ve psikometrik testler kullanılarak değerlendirilmesidir. Gereç ve Yöntem: Bariatrik cerrahinin psikiyatrik uygunluğunun değerlendirilmesi amacıyla tarafımıza danışılan 48 obezite hastası çalışmaya dahil edildi. Araştırmaya dahil edilen hastalara sosyodemografik veri formu, Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ), Rosenberg Benlik Saygısı Ölçeği (RBSÖ), Başa Çıkma Tutumları Değerlendirme Ölçeği (COPE), Hollanda Yeme Tutumu Anketi (DEBQ) ve Barratt Dürtüsellik Ölçeği-11 Kısa Formu (BIS-11) uygulandı. Bulgular: Çalışmaya dahil edilen hastaların 32'si (%66.7) kadın ve 16'sı (%33.3) erkeklerden oluşmaktadır. Bariatrik cerrahi adayı hastaların vücut kitle indeksi (VKİ) ortalaması 45.23±8.97 olarak bulundu, cinsiyetler arası VKİ ortalamalarında fark saptanmadı. BDÖ puanlarında cinsiyetler arasında istatistiksel olarak anlamlı fark saptanmadı, BAÖ puanları kadınlarda yüksek bulundu. COPE fonksiyonel olmayan başa çıkma alt grup puan ortalamalarının kadınlarda istatistiksel olarak anlamlı düzeyde yüksek olduğu saptandı. DEBQ, RBSÖ-benlik saygısı alt ölçek ve BIS-11 değerlendirmelerinde cinsiyetler arasında anlamlı fark saptanmadı. Hastalar obezite ve morbid obezite olmak üzere iki gruba ayrılıp BDÖ ve BAÖ puan ortalamaları karşılaştırıldığında obezite grubunda her iki ölçek puanlarının morbid obezite grubundan yüksek olduğu saptandı. Sonuç: Obezite ruhsal bileşenlerin olduğu multisistem bir bozukluktur. Obezitenin ruhsal bileşenlerini ve bunların cinsiyetler arası farklılıklarını dikkate almak hastanın gerek cerrahi gerekse cerrahi dışı yöntemlerle tedaviye uyumunu kolaylaştırmada ve yinelemelerin önlenmesinde önemli bir basamak olarak değerlendirilmelidir.

Anatolian Journal of Psychiatry, 2019

Objective: Community mental health centers constitute the core of the community-based mental heal... more Objective: Community mental health centers constitute the core of the community-based mental health service model. Some of the patients enrolled in these centers that provide support to individuals and their families with severe mental disorders are staying in a nursing home. In this study, it was aimed to compare the sociodemog- raphic, clinical and drug treatment characteristics of the patients living in nursing home with the patients living at home. Methods: The study included a total of 135 patients who were diagnosed with schizophrenia according to DSM-5 criteria and who attended to rehabilitation program at community mental health centers of Selcuk University Faculty of Medicine, Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, Konya Numune Hospital and Konya Eregli State Hospital at least one day in a month. The study design was retrospective, the data collection forms were filled using hospital medical records. Results: A total of 135 patients with schizophrenia were included in the study. While 82 (60.7%) of the patients were living at home, 53 (39.3%) were in the nursing home. The rate of male patients in the nursing home, the average age, the number of days they participated in the rehabilitation program, the duration of the illness, and the smoking rate were significantly higher than the patients who were living at home. When all patients using multiple antipsychotics were evaluated, positive correlation was found between the number of drugs and side effect scale score, Positive and Negative Syndrome Scale total score. According to the logistic regression analysis to determine the variables predicting the use of single antipsychotic or multiple antipsychotic drugs, the male gender and the number of hospitalizations were found to increase the rate of combined drug use. Discussion: In order to improve the service provided in community mental health centers, it is necessary to identify the need areas of patients according to living conditions in nursing home or home, to share the good practices in psychosocial interventions and to increase the awareness in drug treatments in order to make new arrangements in line with the recommendations of the treatment guidelines.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2016

Psychotherapy perspective of physicians and psychiatric patients Objective: In this study, we aim... more Psychotherapy perspective of physicians and psychiatric patients Objective: In this study, we aimed to investigate the role of psychotherapy in healing and protection of mental health in integrated psychiatry and general medicine practice. Method: This study is a cross-sectional study that was conducted in Konya Training and Research Hospital between dates May 2013 and July 2013. Data were collected by using 5-item questionnaires prepared separately for patients and doctors from internal medicine and surgical disciplines. Results: The sample is consisting of 173 patients admitted to psychiatric outpatient clinic, 28 doctors from surgical and 89 doctors from internal medicine disciplines. Patients at psychiatric outpatient clinic believed that psychotherapy was an effective method for the treatment of psychiatric disorders, and knew that psychiatrists could apply psychotherapy, but thought that there was no sufficient time at outpatient clinics. No difference was determined between the doctors from internal medicine and surgical disciplines in tendency to ask support from psychiatrists for treatment of their patients (p=0.115). Doctors from internal medine disciplines had a higher proportion of belief that psychotherapy was as effective as medication treatments (p=0.038). No difference was determined between doctors from internal medicine and surgical disciplines in the belief that psychiatrists could provide psychotherapy service. Belief of applicability of psychotherapy at the outpatient clinic settings was higher among doctors from internal medicine than those from the surgical disciplines (p=0.038). Conclusion: This study enabled us to assess the attitudes towards "psychotherapy" among patients and doctors from internal medicine and surgical disciplines.

The Journal of Trauma: Injury, Infection, and Critical Care, 2010

Background: Southwestern Ontario largely comprises rural farming districts and is home to numerou... more Background: Southwestern Ontario largely comprises rural farming districts and is home to numerous Old-Order Anabaptist settlements. Our objective was to describe the injuries sustained by rural children, both Old-Order Anabaptist and non-Anabaptist, to better target injury prevention programs. Methods: We retrospectively examined injury data of rural children in Southwestern Ontario with injury severity scores Ն12 obtained from hospital and trauma databases (1997-2007). Results: A total of 422 rural children were included in this study: 7.8% Anabaptist (n ϭ 33) and 92.2% non-Anabaptist (n ϭ 389). The age of injured Anabaptist children (median, 7 years; interquartile range ϭ 10) was younger than non-Anabaptist children (median, 14 years; interquartile range ϭ 7; p Ͻ 0.001). Anabaptist children were most frequently injured on their property (48.5%; n ϭ 16 of 33; p Ͻ 0.001). Non-Anabaptist children were mostly injured on roads (56.8%; n ϭ 221 of 389; p Ͻ 0.05) and by motor vehicle collisions (MVCs; 40.1%; n ϭ 156 of 389; p ϭ 0.02). Frequent causes of injury among Anabaptist children were falls (24.2%; n ϭ 8 of 33; p ϭ 0.02), animals (15.2%; n ϭ 5 of 33; p ϭ 0.004), and buggies (9.1%; n ϭ 3 of 33). Approximately half of both groups injured in MVCs did not use seat belts. There were no significant differences between cohorts in sex, injury severity scores, hospitalization days, rates of complications, interventions, comorbidities, or mortality rates. Conclusions: Injuries to Anabaptist children occur at a young age, primarily on their property, and exhibit a unique spectrum of mechanisms. In contrast, injuries to non-Anabaptist children occur at an older age, primarily on roads, and in MVCs. The use of protective devices was low among all rural children. Development of collaborative injury prevention programs targeted to distinct rural communities, including Anabaptist and non-Anabaptist, are needed for reducing injuries among rural children.

Konuralp Tıp Dergisi, 2017

OZET Amac: Psikiyatrik hastalik varligi sigara birakma tedavisine engel olmamasina ragmen bu hast... more OZET Amac: Psikiyatrik hastalik varligi sigara birakma tedavisine engel olmamasina ragmen bu hastalarda sigara birakma tedavisi oncelikli hedefler arasinda yer almamaktadir. Bu calismanin amaclari; psikiyatri poliklinigine basvuran hastalarin; sigara kullanma aliskanliklarini arastirmak, muayene olduklari psikiyatrist tarafindan sigara kullanma aliskanliklarinin kendilerine sorulup sorulmadigini degerlendirmek, sigara kullanan hastalarin sigarayi birakma isteklerini degerlendirmek, sigara birakma konusunda psikiyatri polikliniklerinden yardim alinabilecegi bilgisine sahibi olup olmadiklarini ogrenmek ve “sigara bagimliligi ve tedavisi” konusunda yapilan hizmet ici egitimin psikiyatristlerin sigara kullanimini sorgulama durumlarina etkisini degerlendirmekti. Yontem: Konya Egitim ve Arastirma Hastanesi Beyhekim Psikiyatri Klinigi Poliklinik Unitesi’ne; Haziran 2013 - Temmuz 2013 tarihleri arasinda basvuran tum hastalara ilk asamada, muayene sonrasi bes soruluk anket uygulandi. Muayene esnasinda sigara kullanimi sorgulama tutumlarini etkilememek icin poliklinik doktorlarina anket calismasi hakkinda bilgi verilmedi. Eylul 2013 tarihinde, psikiyatri polikliniginde calisan doktorlara “Sigara Bagimliligi ve Tedavisi” konusunda seminer, calismanin ikinci asamasinda; seminer almis bu doktorlarin hastalarina ayni anket uygulandi. Bulgular: Calismaya katilan hastalarin %51,1’i (n=203) sigara iciyordu. Calismanin ilk asamasinda doktorlar hastalarin %18,3’unde (n=40), ikinci asamasinda %53,1’inde (n=95) sigara kullanimini sorgulamisti, egitim semineri sonrasi doktorlarin sigara kullanimini sorgulama orani anlamli olarak artmisti (p<0.001). Calismaya katilan tum hastalarin %37,9’unun (n=69) sigara birakma istegi mevcuttu ve %46,9’u (n=186) sigara birakma konusunda psikiyatriden yardim alinabilecegini biliyordu. Sonuc: “Sigara Bagimliligindan kurtulma sansi" psikiyatri poliklinik hizmetleri kapsaminda hastalara sunulmali, psikiyatri doktorlarinin konu ile ilgili bilgilerinin ve ilgilerinin artmasi yonunde calismalar yapilmalidir. Anahtar Kelimeler: Psikiyatrik Bozukluk, Psikiyatrist, Sigara Icme, Sigara Birakma

Therapeutic Advances in Psychopharmacology, 2015

Objective: Clozapine is a second-generation antipsychotic used for treatment-resistant schizophre... more Objective: Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia. Despite its effectiveness, clozapine is largely underused due to serious side effects such as leukopenia or neutropenia. We aimed to review whether to continue, discontinue or rechallenge clozapine treatment after such haematological side effects. Methods: We reviewed and summarized the literature on the use of clozapine, how to deal with its side effects, and suitable options in case of any haematological problems. Then, we described several cases successfully treated with clozapine and lithium after development of neutropenia or leukopenia Results: We present three patients with treatment-resistant schizophrenia. While they had demonstrated poor response to multiple antipsychotic trials, clozapine was started. Clozapine induced neutropenia; or leukopenia developed in some cases that was successfully reversed after lithium onset. Increased serious side effects related with coprescr...

Amac: Oksidatif stres ile antioksidan savunma mekanizmalari arasindaki denge ve bu dengenin bozul... more Amac: Oksidatif stres ile antioksidan savunma mekanizmalari arasindaki denge ve bu dengenin bozulmasinin bircok hastaligin gelisimi ve prognozunda onemli bir rolu oldugu dusuncesi gun gectikce daha fazla kabul gormektedir. Bu calismada, yasadiklari yuksek stresin getirdigi oksidatif hasar baz alinarak sizofreni hastalari uzerinden bu hasara bagli olarak aciga cikan diger oksidatif stres belirtecleri ile idrar malondialdehit olcumlerinin karsilastirilmasi ve korelasyonunun arastirilmasi amaclanmistir. Hastalar ve Yontem: Calismaya Marmara Universitesi Hastanesi Psikiyatri poliklinigine basvuran 20 sizofreni hastasi ve 21 saglikli kontrol alinmis, hastalardan ve kontrol grubundan alinan kan ve idrar orneklerinde oksidatif stres parametreleri incelenmistir. Bulgular: Bulgularimiz, oksidatif stres ile ilgili parametrelerden yukseltgenmis glutatyon, plazma lipid peroksidasyonu ve idrar malondialdehit duzeylerinin sizofreni hastalarinda kontrollere gore daha yuksek oldugunu, ayrica ozelli...

Journal of Orthopaedic Surgery and Research

Purpose The aim of this study was to investigate the effect of clozapine use on bone tissue by ap... more Purpose The aim of this study was to investigate the effect of clozapine use on bone tissue by applying computerized tomography, dual-energy X-ray absorptiometry, and histological and biomechanical analyses in an experimental rat model. Methods Sixteen female Wistar Albino rats were included in this study. These animals were divided into two groups: the control group and the clozapine group. The animals in the clozapine group received 10 mg/kg clozapine, and the animals in the control group received tap water by oral gavage daily for 28 days. After sacrification, the femurs of the rats were used for radiologic, histologic, dual-energy X-ray absorptiometry, and biomechanical evaluations. Results Although the mean values of the clozapine group were higher in terms of histological, bone mineral density, and biomechanical evaluations, the statistical analyses were not significantly different. Conclusion Clozapine use did not affect bone density in the rats. Clozapine can be the preferre...

International Journal of Bipolar Disorders

Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal b... more Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly...

International Clinical Psychopharmacology

The aim of this study was to evaluate discontinuation and hospitalization rates in patients with ... more The aim of this study was to evaluate discontinuation and hospitalization rates in patients with schizophrenia spectrum disorder who were treated with long-acting injectable (LAI) antipsychotics. We recorded clinical data about the period before the LAI treatment, when LAI treatment was initiated, and during the LAI treatment. Variables related to early (<8 weeks) and other LAI discontinuations and hospitalization were analyzed. Out of 452 patients, 14.4% of them discontinued their LAI treatment before 8 weeks, another 24.8% of the patients stopped their LAI by themselves later. Early discontinuers were younger, had shorter duration of illness, and less educated. Sixty-two (27.2%) of the patients were hospitalized under LAI treatment and 40% of the hospitalizations occurred in initial 6 months. Rate of hospitalization was 36.1% in the group who discontinued LAI after 8 weeks. In logistic regression analysis, younger age, history of combined antipsychotic treatment, number of hospitalizations before LAI, use of LAI for less than 6 months and alcohol abuse under LAI treatment were found related to hospitalization. Our findings suggested that discontinuation and hospitalization are still common among the patients who were treated with LAI antipsychotics.

Journal of Pharmaceutical and Biomedical Analysis

OBJECTIVE Clozapine is one of the most effective drugs for resistant schizophrenia, but its sever... more OBJECTIVE Clozapine is one of the most effective drugs for resistant schizophrenia, but its severe metabolic and hematological side effects limit the use of clozapine. It has been reported that clozapine blood concentrations should be maintained between 350-600 ng/mL. Our aim was to develop a determination method for clozapine and its main metabolites norclozapine and clozapine-N-oxide, to perform validation studies and to investigate the change of various biochemical parameters in patients using clozapine. METHODS A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for clozapine measurement. Thus, blood samples were collected from 38 patients with schizophrenia and 32 healthy volunteers. Biochemical and hematological parameters were measured by Beckman-Coulter AU 5800 (Beckman Coulter, Brea, USA) and Beckman Coulter LH 780 analyzer (Beckman Coulter, Miami, FL, USA), respectively. Hormone levels were analyzed using Cobas 6000 analyzer (Roche Diagnostics, Germany). RESULTS The LCMS/MS method was linear between 1.22-2500 ng/mL (r2 = 0.9971) for clozapine. The retention times of clozapine, norclozapine and clozapine-N-oxide were 0.92, 0.89 and 0.95, respectively. Blood glucose (GLU) (p = 0.025), low density lipoprotein (LDL-cholesterol) (p = 0.015), triglyseride (TG) (p = 0.042) and total cholesterol (TC) (p = 0.024) levels were higher; hemoglobin (HGB) (0.015), mean corpuscular hemoglobin (MCH) (0.036), red blood cell count (RBC) (0.020), neutrophil (NEU) (0.034), and platelet (PLT) (P = 0.005) levels were lower in the clozapine group. CONCLUSIONS This LC-MS/MS method was rapid, simple, cost-effective and suitable for the routine clozapine monitoring. Furthermore, norclozapine and clozapine-N-oxide were also determined. Monitoring of metabolic and hematological parameters with clozapine levels is very important. However, the limitations of the study were that the method was not validated for norclozapine and clozapine-N-oxide, so the validation parameters were not evaluated for these two metabolites.