Murat İlhan Atagün | çanakkale 18 mart (original) (raw)

Papers by Murat İlhan Atagün

Psychiatry and Clinical Psychopharmacology, 2019

OBJECTIVE: In this study, we aimed to study copper metabolism in schizophrenia, bipolar disorder,... more OBJECTIVE: In this study, we aimed to study copper metabolism in schizophrenia, bipolar disorder, major depression compared with healthy control. METHODS: This is a single-centered cross-sectional study. The patients with schizophrenia (n = 36), bipolar disorder (n = 37), major depression (n = 40), and healthy control (n = 32) were included in the study. All participants were initially evaluated by a clinical psychiatrist to confirm the appropriate diagnosis using the Structured Clinical Interview for Diagnostic and Statistical Manuel of Mental Disorders-IV (DSM-IV) Axis I Disorders (SCID-I). Serum copper level, ceruloplasmin mass, and ceruloplasmin-ferroxidase activity were measured. One-way ANOVA and Kruskal-Wallis Tests were performed for statistical analyses. RESULTS: Serum ceruloplasmin-ferroxidase activity (χ 2 = 9.11, p = 0.028) demonstrated a significant statistical difference in all groups compared with the control group. Serum ceruloplasmin-ferroxidase activity of the bipolar disorder group was significantly higher than the healthy control group (p = 0.012), major depression group (p = 0.027), and the schizophrenia group (p = 0.019). Erythrocyte sedimentation rate (ESR) (p = 0.028) and waist circumference (p = 0.005) in bipolar disorder group, and the C-reactive protein (CRP) (p < 0.001) and cholesterol (p = 0.043) in the schizophrenia group were found as the determinants of ceruloplasmin-ferroxidase activity. CONCLUSION: In this study, ceruloplasmin-ferroxidase activity is higher in all groups in comparison to the healthy control. The significantly higher ceruloplasmin-ferroxidase activity was shown in bipolar disorder followed by the major depression and schizophrenia. The ceruloplasmin-ferroxidase activity was correlated with erythrocyte sedimentation rate in the bipolar disorder group and with C-reactive protein in the schizophrenia group. Therefore, the ceruloplasmin-ferroxidase activity may be an encouraging candidate in the neuro-immune modulation and become a reliable clinical tool for demonstrating the strong association of inflammation in these disorders.

Psychiatry and Clinical Psychopharmacology, 2018

OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is calle... more OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p < 0.001) were the determinants of IMA levels with linear regression analysis. CONCLUSION: Elevation of IMA levels may indicate a global metabolic risk, and IMA levels are elevated in the BD group in this study. Determinants of IMA levels may indicate the significant metabolic risk in patient groups. Oxidative stress (OS) was the determinant of IMA levels in the SZ, and white blood cell count was the determinant of IMA levels in the BD group. Although the IMA levels were higher in all patient groups, the statistical significance appeared only in the BD group. Elevated IMA level was due to elevated OS in the SZ group, whereas the immunity in the BD group.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2018

Information processing abnormalities in schizophrenia and bipolar disorder Objective: Patients wi... more Information processing abnormalities in schizophrenia and bipolar disorder Objective: Patients with bipolar disorder and schizophrenia exhibit abnormalities in attention, memory, working memory, verbal/visual learning and executive functions. However, many of the tests fail to detect slight changes in cognitive performance due to ceiling effect. It was aimed to determine sensitivity and specificity of the tests that measure information processing in schizophrenia and bipolar disorder in this study. Method: Thirty four patients with schizophrenia, 35 patients with bipolar disorder according to DSM-IV and 33 healthy control subjects matched for age, education level and gender were enrolled to the study. For clinical assessments Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale, Young Mania Rating Scale, Clinical Global Impression Scale and Abnormal Involuntary Movements Scale were used. All participants performed a battery consisting of tests measuring information processing including Adult Memory and Information Processing Battery (AMIPB), Trail Making Test (TMT) Form A and B, Digit Symbol Coding Task (DST) and Auditory and Visual Reaction Time Tests (RTT). Results: The schizophrenia group had significantly lower performance than the healthy control group in all tests and lower performance than the bipolar disorder group in AMIPB-A and B tests, TMT A and B tests. The bipolar disorder group had lower performance than the healthy control group only in DST test. The AMIPB A and B tests were the most sensitive and specific tests in the ROC analysis. Conclusion: Changes in cognitive function might be better monitored by the tests whose sensitivity and specificity are higher. Since psychiatric disorders are highly heterogeneous, measurement tools are important for precise measurements.

TURKISH JOURNAL OF MEDICAL SCIENCES, 2016

To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively... more To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively in psychiatric disorders. Previous studies have reported alterations in the number (1,2) and function (3) of blood cells in psychiatric disorders. Alterations might be related to different etiologies in different psychiatric disorders (1) and medications (4,5). After the reversal of these mechanisms by successful treatment with escitalopram, the platelet volumes were normalized in first episode, medication-naïve patients with major depressive disorder (6). In bipolar disorder, mood stabilizers seem to be the major reason for the changes in blood cells (4,5). In patients with psychotic spectrum disorders, the mean platelet volume (MPV) is increased, especially in patients on atypical antipsychotics (7). We have analyzed the blood cell counts of outpatients in our clinic between 1 January, 2012 and 31 December, 2014. Major depressive disorder (n = 338), bipolar disorder (n = 389), and psychotic spectrum disorders (n = 227) were the diagnostic groups examined in our analysis. The results of

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 2016

The changes of the cognitive and psychomotor functions in the chronic cannabis users after a mont... more The changes of the cognitive and psychomotor functions in the chronic cannabis users after a month of remission Objective: In our study, it is aimed to investigate impacts of cannabis use on information processing and psychomotor functions and to examine changes in the cognitive functions at the end of abstinence over a month. Method: The study was initiated with 34 volunteer participants using cannabis at least over two years, directed by a forensic unit. 34 persons were assessed at admission and were planned to assess after a month of remission. As 14 participants discontinued the study 20 participants only were assessed again at the end of a month. The participants were applied The Montreal Cognitive Assessment (MOCA) test, Edinburgh Handedness Inventory, Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB) A and B, and simple reaction time tests (auditory and visual) in admission and were applied Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB), and simple reaction time tests (auditory and visual) at the end of a month. Results: There was no statistically significant difference between participants continue to the treatment and those discontinue in terms of sociodemographic and clinical characteristics. The participants discontinue were using more daily cannabis dose. The auditory reaction time of the group continue to the treatment decreased statistically significantly after a month whereas there was no statistically significant difference in the visual reaction time. The scores of the AMIPB-A and AMIPB-B were detected statistically higher after a month compared to admission. The score of the dominant hand FTT after a month was detected statistically higher than that in admission whereas there was no statistically significant difference in the non-dominant hand score. Conclusion: Improvements in scores of AMIP-A, AMIP-B, FTT and auditory reaction time after one month of quitting cannabis suggest that cannabis use may impair cognitive functions such as information processing, reaction time and motor functions. We suggest that future studies to assess cognitive functions after either a shorter (i.e. 1 week) or a longer (i.e. 2 months) period of cannabis abstinence in larger samples may provide further useful data about the relationship between cannabis use and cognitive functions.

Düşünen Adam, Sep 15, 2012

Mental symptoms are related with impact of the disease and impairment in quality of life in femal... more Mental symptoms are related with impact of the disease and impairment in quality of life in female patients with fibromyalgia Objective: Diagnostic criteria of fibromyalgia are revised in 2010 by including mental symptoms and excluding tender points. Although dominance of pain still prevails on the diagnostic criteria, quality of life (QoL) surveys showed that fibromyalgia is strongly associated with mental components of health status, i.e. depression, anxiety and alexithymia. It is aimed to assess determinants of QoL and impact of the disease in patients with fibromyalgia. Methods: Fifty seven female outpatients (mean age±SD: 40.93±6.85; age range: 24-56) with fibromyalgia were enrolled. Fibromyalgia Impact Questionnaire, Short Form-36 QoL survey, Beck Depression Inventory, State-Trait Anxiety Inventory, 20-item Toronto Alexithymia Scale were the measurement tools. Results: Predictor of impact of the disease was alexithymia, particularly, difficulty in identifying feelings (DIF) domain. Predictor of physical health was age, whereas predictors of mental health were depression and trait anxiety. Discussion: Alexithymia, particularly DIF domain may be a more specific predictor of fibromyalgia symptoms, whereas depression and anxiety are more burdensome mental symptoms for fibromyalgia. Pain and mental symptoms are seemed to be processed separately. Targeting mental symptoms may provide better treatment outcomes, thus multidisciplinary approaches including psychiatry are necessary.

Ankara Medical Journal, 2015

Objectives: According to the common view, there is no adequate information in psychiatry literatu... more Objectives: According to the common view, there is no adequate information in psychiatry literature about the connection between on one side "anxiety sensitivity" indicating an intrinsic anxiety tendency or a personality trait and on the other side suicide. This study is planned based on the hypothesis whether higher anxiety sensitivity is a preventive factor in terms of suicide. Materials and Methods : The study comprises of two groups: one consisting of 31 patients with unipolar depression diagnosis according to DSM-IV-TR, who have never attempted and still had no thought of suicide and the other consisting of 28 patients resorted to Ankara Atatürk Training and Research Hospital psychiatry outpatient department or Ankara Atatürk Training and Research Hospital emergency service upon attempting suicide. Anxiety Sensitivity Index-3 (ASI), Suicide Probability Scale (SPS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) are conducted for the patients after receiving their informed consents. In addition, three sub-scales of Anxiety Sensitivity Index-3-social, cognitive and physical-are investigated with individual scoring. Results: There were 28 patients in the depression group with suicide history (group 1) and 31 patients in the depression group without suicide history (group 2). No difference associated with age, education, gender and marital status is detected. The difference with respect to total point of anxiety sensitivity index (Mgroup1 = 27.2 ± 16.9, Mgroup2 = 35.9 ± 15.2, t = 2.045, p = 0.045), scores of "physical" sub-scale (Mdngroup1 = 5.5, Mdngroup2 = 10, Z =-1.989, p = 0.047) and total points of Beck Depression Inventory between groups is considered significant. No statistically significant intergroup difference is detected in total points of ASI-3's social and cognitive sub-scales, BAI and SPS. Conclusion: As ASI-3 is a scale measurable in a short time for evaluating the suicide risk in depression patients, it can be suggested hereby that ASI-3 can be helpful for clinical use.

The European Research Journal, 2015

Turkish Journal of Psychiatry, 2014

Delusional misidentification syndrome develops in conjunction with other psychiatric and neurolog... more Delusional misidentification syndrome develops in conjunction with other psychiatric and neurologic diseases, and is characterized by an individual's belief that the identity of a person, place, object, or event has somehow been replaced or altered (Bilici et al. 2011). We present an interesting case that represents a novel presentation of delusional misidentification syndrome.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2011

Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine... more Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine the frequency of psychiatric morbidity in vitiligo patients treated at the dermatology outpatient clinic and to investigate the relation between anxiety, depression, social anxiety levels, and self esteem and disability in these patients. Method: Fourty-two patients with vitiligo were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), Liebowitz Social Anxiety Scale (LSAS) and Sheehan Disability Scale (SDS). Control group included subjects matched to patients in terms of age, sex and education level. Results: In comparison to healthy controls, the rate of psychiatric morbidity was found to be higher and mean self-esteem score was found to be lower in the vitiligo group. There was no significant difference between groups in terms of social anxiety. Majority of the patients were mildly disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in female and young participants. Anxiety and social avoidance scores negatively correlated with age. Conclusion: These findings suggest that the rate of psychiatric morbidity is higher in patients with vitiligo than healthy control subjects. Patients with vitiligo treated at dermatology clinics should be assessed in terms of psychiatric disorders and psychiatric interventions may become necessary in the course of illness.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıl... more Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıldır şizofreni tedavisinde kullanılmaktadır ve kayda değer yan etkileri bulunmasına rağmen, tedaviye dirençli şizofrenide halen altın standarttır. Klozapin tedavisi sırasında sık karşılaşılan ve hastaların yaşam kalitesini önemli düzeyde etkileyebilen bir yan etki de siyaloredir. Klozapinin belirgin antikolinerjik yan etkilerine karşın, halen hangi mekanizmayla siyaloreye neden olduğu net biçimde bilinmemektedir. Sık karşılaşılmasına ve yaşam kalitesini belirgin biçimde etkileyebilmesine rağmen, siyalorenin tedavisinde halen mevcut seçeneklerin başarı oranı kısıtlıdır. Bu yazıda, klozapine bağlı gelişen siyalorenin patofizyolojisi ve tedavi seçenekleri güncel bilgiler ışığında gözden geçirilmiştir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha ç... more Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha çok şizofreninin bir alt grubu olarak değerlendirilmiş olsa da, birçok genel tıbbi durum, nörolojik hastalık ya da bazı ilaçlara bağlı olarak da ortaya çıkabilir. Disülfiram, alkol bağımlılığı tedavisinde caydırıcı etkisi nedeniyle kullanılabilen bir ajandır. Psikoz ve deliryum gibi nöropsikiyatrik yan etkilere neden olabilir. Katatonik sendrom disülfiramın çok nadir görülen bir yan etkisidir. Bu yazıda, kliniği bilişsel işlevlerde bozulma ile başlayan ve katatonik sendroma dönüşen bir vaka sunulmaktadır. Hastanın alkol kötüye kullanımı dışında psikiyatrik öyküsü yoktu ve son 1 aydır, reçetesiz temin ettiği disülfiramı kullanıyordu. Hastaya, disülfirama bağlı katatoni tanısı ile elektrokonvülsif tedavi uygulandı. Tam düzelme sağlanan ve ilaçsız izlenen vakanın iyilik hali devam etti. Bu çalışmada, örnek vaka çerçevesinde katatoni kavramı tartışılmaktadır.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıl... more Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıldır şizofreni tedavisinde kullanılmaktadır ve kayda değer yan etkileri bulunmasına rağmen, tedaviye dirençli şizofrenide halen altın standarttır. Klozapin tedavisi sırasında sık karşılaşılan ve hastaların yaşam kalitesini önemli düzeyde etkileyebilen bir yan etki de siyaloredir. Klozapinin belirgin antikolinerjik yan etkilerine karşın, halen hangi mekanizmayla siyaloreye neden olduğu net biçimde bilinmemektedir. Sık karşılaşılmasına ve yaşam kalitesini belirgin biçimde etkileyebilmesine rağmen, siyalorenin tedavisinde halen mevcut seçeneklerin başarı oranı kısıtlıdır. Bu yazıda, klozapine bağlı gelişen siyalorenin patofizyolojisi ve tedavi seçenekleri güncel bilgiler ışığında gözden geçirilmiştir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha ç... more Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha çok şizofreninin bir alt grubu olarak değerlendirilmiş olsa da, birçok genel tıbbi durum, nörolojik hastalık ya da bazı ilaçlara bağlı olarak da ortaya çıkabilir. Disülfiram, alkol bağımlılığı tedavisinde caydırıcı etkisi nedeniyle kullanılabilen bir ajandır. Psikoz ve deliryum gibi nöropsikiyatrik yan etkilere neden olabilir. Katatonik sendrom disülfiramın çok nadir görülen bir yan etkisidir. Bu yazıda, kliniği bilişsel işlevlerde bozulma ile başlayan ve katatonik sendroma dönüşen bir vaka sunulmaktadır. Hastanın alkol kötüye kullanımı dışında psikiyatrik öyküsü yoktu ve son 1 aydır, reçetesiz temin ettiği disülfiramı kullanıyordu. Hastaya, disülfirama bağlı katatoni tanısı ile elektrokonvülsif tedavi uygulandı. Tam düzelme sağlanan ve ilaçsız izlenen vakanın iyilik hali devam etti. Bu çalışmada, örnek vaka çerçevesinde katatoni kavramı tartışılmaktadır.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Mental symptoms are related with impact of the disease and impairment in quality of life in femal... more Mental symptoms are related with impact of the disease and impairment in quality of life in female patients with fibromyalgia Objective: Diagnostic criteria of fibromyalgia are revised in 2010 by including mental symptoms and excluding tender points. Although dominance of pain still prevails on the diagnostic criteria, quality of life (QoL) surveys showed that fibromyalgia is strongly associated with mental components of health status, i.e. depression, anxiety and alexithymia. It is aimed to assess determinants of QoL and impact of the disease in patients with fibromyalgia. Methods: Fifty seven female outpatients (mean age±SD: 40.93±6.85; age range: 24-56) with fibromyalgia were enrolled. Fibromyalgia Impact Questionnaire, Short Form-36 QoL survey, Beck Depression Inventory, State-Trait Anxiety Inventory, 20-item Toronto Alexithymia Scale were the measurement tools. Results: Predictor of impact of the disease was alexithymia, particularly, difficulty in identifying feelings (DIF) domain. Predictor of physical health was age, whereas predictors of mental health were depression and trait anxiety. Discussion: Alexithymia, particularly DIF domain may be a more specific predictor of fibromyalgia symptoms, whereas depression and anxiety are more burdensome mental symptoms for fibromyalgia. Pain and mental symptoms are seemed to be processed separately. Targeting mental symptoms may provide better treatment outcomes, thus multidisciplinary approaches including psychiatry are necessary.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotip... more İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotipler Bilişsel işlev bozuklukları iki uçlu bozukluğun klinik düzelme dönemlerinde dahi hastaları etkilemektedir. Başta sözel öğrenme, sözel bellek ve yürütücü işlev bozuklukları olmak üzere faal bellek, dikkat, dikkati sürdürme ve işlem hızı iki uçlu bozuklukta öne çıkan alt bilişsel alanlardır. Sözel öğrenme ve sözel bellek hastaların yanında birinci derece akrabalarda da en fazla etkilenmiş işlevler olduklarından hastalıkla ilgili bir özellik olabilir, dolayısıyla bilişsel ara fenotip kavramına en uygun aday gibi görünmektedirler. Psikotik hastalık dönemlerinin olup olmaması, geçirilen hastalık dönemi tip ve sayıları, hastalığın başlangıç yaşı ve hastalık süresi bilişsel kayıpları etkilediği belirlenmiş klinik parametrelerdir. İki uçlu bozuklukların erken başlangıçlı formları, tip II bozukluk, yaşlılık ve komorbidite varlığı durumlarında bilişsel işlevlerin nasıl etkilendiği ile ilgili sınırlı sayıda araştırma bulunmaktadır. Ayrıca ilaçların bilişsel işlevleri kalitatif ve kantitatif olarak nasıl etkilediği ile ilgili yeterli ve tutarlı kanıt bulunmamaktadır. Hastaların birinci derece akrabalarında bilişsel kayıpların görülmesi ve kayıpların ailesel benzerlik göstermesi bilişsel işlevler için kalıtım göstergesi olabilir, bu nedenle araştırmaların desenlenmesinde genetik modellerin dikkate alınması önemli veriler sağlayabilir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bi... more Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder Objective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians' attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64±10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotip... more İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotipler Bilişsel işlev bozuklukları iki uçlu bozukluğun klinik düzelme dönemlerinde dahi hastaları etkilemektedir. Başta sözel öğrenme, sözel bellek ve yürütücü işlev bozuklukları olmak üzere faal bellek, dikkat, dikkati sürdürme ve işlem hızı iki uçlu bozuklukta öne çıkan alt bilişsel alanlardır. Sözel öğrenme ve sözel bellek hastaların yanında birinci derece akrabalarda da en fazla etkilenmiş işlevler olduklarından hastalıkla ilgili bir özellik olabilir, dolayısıyla bilişsel ara fenotip kavramına en uygun aday gibi görünmektedirler. Psikotik hastalık dönemlerinin olup olmaması, geçirilen hastalık dönemi tip ve sayıları, hastalığın başlangıç yaşı ve hastalık süresi bilişsel kayıpları etkilediği belirlenmiş klinik parametrelerdir. İki uçlu bozuklukların erken başlangıçlı formları, tip II bozukluk, yaşlılık ve komorbidite varlığı durumlarında bilişsel işlevlerin nasıl etkilendiği ile ilgili sınırlı sayıda araştırma bulunmaktadır. Ayrıca ilaçların bilişsel işlevleri kalitatif ve kantitatif olarak nasıl etkilediği ile ilgili yeterli ve tutarlı kanıt bulunmamaktadır. Hastaların birinci derece akrabalarında bilişsel kayıpların görülmesi ve kayıpların ailesel benzerlik göstermesi bilişsel işlevler için kalıtım göstergesi olabilir, bu nedenle araştırmaların desenlenmesinde genetik modellerin dikkate alınması önemli veriler sağlayabilir.

Psychiatry and Clinical Psychopharmacology, 2019

OBJECTIVE: In this study, we aimed to study copper metabolism in schizophrenia, bipolar disorder,... more OBJECTIVE: In this study, we aimed to study copper metabolism in schizophrenia, bipolar disorder, major depression compared with healthy control. METHODS: This is a single-centered cross-sectional study. The patients with schizophrenia (n = 36), bipolar disorder (n = 37), major depression (n = 40), and healthy control (n = 32) were included in the study. All participants were initially evaluated by a clinical psychiatrist to confirm the appropriate diagnosis using the Structured Clinical Interview for Diagnostic and Statistical Manuel of Mental Disorders-IV (DSM-IV) Axis I Disorders (SCID-I). Serum copper level, ceruloplasmin mass, and ceruloplasmin-ferroxidase activity were measured. One-way ANOVA and Kruskal-Wallis Tests were performed for statistical analyses. RESULTS: Serum ceruloplasmin-ferroxidase activity (χ 2 = 9.11, p = 0.028) demonstrated a significant statistical difference in all groups compared with the control group. Serum ceruloplasmin-ferroxidase activity of the bipolar disorder group was significantly higher than the healthy control group (p = 0.012), major depression group (p = 0.027), and the schizophrenia group (p = 0.019). Erythrocyte sedimentation rate (ESR) (p = 0.028) and waist circumference (p = 0.005) in bipolar disorder group, and the C-reactive protein (CRP) (p < 0.001) and cholesterol (p = 0.043) in the schizophrenia group were found as the determinants of ceruloplasmin-ferroxidase activity. CONCLUSION: In this study, ceruloplasmin-ferroxidase activity is higher in all groups in comparison to the healthy control. The significantly higher ceruloplasmin-ferroxidase activity was shown in bipolar disorder followed by the major depression and schizophrenia. The ceruloplasmin-ferroxidase activity was correlated with erythrocyte sedimentation rate in the bipolar disorder group and with C-reactive protein in the schizophrenia group. Therefore, the ceruloplasmin-ferroxidase activity may be an encouraging candidate in the neuro-immune modulation and become a reliable clinical tool for demonstrating the strong association of inflammation in these disorders.

Psychiatry and Clinical Psychopharmacology, 2018

OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is calle... more OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p < 0.001) were the determinants of IMA levels with linear regression analysis. CONCLUSION: Elevation of IMA levels may indicate a global metabolic risk, and IMA levels are elevated in the BD group in this study. Determinants of IMA levels may indicate the significant metabolic risk in patient groups. Oxidative stress (OS) was the determinant of IMA levels in the SZ, and white blood cell count was the determinant of IMA levels in the BD group. Although the IMA levels were higher in all patient groups, the statistical significance appeared only in the BD group. Elevated IMA level was due to elevated OS in the SZ group, whereas the immunity in the BD group.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2018

Information processing abnormalities in schizophrenia and bipolar disorder Objective: Patients wi... more Information processing abnormalities in schizophrenia and bipolar disorder Objective: Patients with bipolar disorder and schizophrenia exhibit abnormalities in attention, memory, working memory, verbal/visual learning and executive functions. However, many of the tests fail to detect slight changes in cognitive performance due to ceiling effect. It was aimed to determine sensitivity and specificity of the tests that measure information processing in schizophrenia and bipolar disorder in this study. Method: Thirty four patients with schizophrenia, 35 patients with bipolar disorder according to DSM-IV and 33 healthy control subjects matched for age, education level and gender were enrolled to the study. For clinical assessments Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale, Young Mania Rating Scale, Clinical Global Impression Scale and Abnormal Involuntary Movements Scale were used. All participants performed a battery consisting of tests measuring information processing including Adult Memory and Information Processing Battery (AMIPB), Trail Making Test (TMT) Form A and B, Digit Symbol Coding Task (DST) and Auditory and Visual Reaction Time Tests (RTT). Results: The schizophrenia group had significantly lower performance than the healthy control group in all tests and lower performance than the bipolar disorder group in AMIPB-A and B tests, TMT A and B tests. The bipolar disorder group had lower performance than the healthy control group only in DST test. The AMIPB A and B tests were the most sensitive and specific tests in the ROC analysis. Conclusion: Changes in cognitive function might be better monitored by the tests whose sensitivity and specificity are higher. Since psychiatric disorders are highly heterogeneous, measurement tools are important for precise measurements.

TURKISH JOURNAL OF MEDICAL SCIENCES, 2016

To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively... more To the Editor Blood cells in circulation could be disturbed both qualitatively and quantitatively in psychiatric disorders. Previous studies have reported alterations in the number (1,2) and function (3) of blood cells in psychiatric disorders. Alterations might be related to different etiologies in different psychiatric disorders (1) and medications (4,5). After the reversal of these mechanisms by successful treatment with escitalopram, the platelet volumes were normalized in first episode, medication-naïve patients with major depressive disorder (6). In bipolar disorder, mood stabilizers seem to be the major reason for the changes in blood cells (4,5). In patients with psychotic spectrum disorders, the mean platelet volume (MPV) is increased, especially in patients on atypical antipsychotics (7). We have analyzed the blood cell counts of outpatients in our clinic between 1 January, 2012 and 31 December, 2014. Major depressive disorder (n = 338), bipolar disorder (n = 389), and psychotic spectrum disorders (n = 227) were the diagnostic groups examined in our analysis. The results of

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 2016

The changes of the cognitive and psychomotor functions in the chronic cannabis users after a mont... more The changes of the cognitive and psychomotor functions in the chronic cannabis users after a month of remission Objective: In our study, it is aimed to investigate impacts of cannabis use on information processing and psychomotor functions and to examine changes in the cognitive functions at the end of abstinence over a month. Method: The study was initiated with 34 volunteer participants using cannabis at least over two years, directed by a forensic unit. 34 persons were assessed at admission and were planned to assess after a month of remission. As 14 participants discontinued the study 20 participants only were assessed again at the end of a month. The participants were applied The Montreal Cognitive Assessment (MOCA) test, Edinburgh Handedness Inventory, Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB) A and B, and simple reaction time tests (auditory and visual) in admission and were applied Finger Tapping Test (FTT), Adult Memory and Information Processing Battery (AMIPB), and simple reaction time tests (auditory and visual) at the end of a month. Results: There was no statistically significant difference between participants continue to the treatment and those discontinue in terms of sociodemographic and clinical characteristics. The participants discontinue were using more daily cannabis dose. The auditory reaction time of the group continue to the treatment decreased statistically significantly after a month whereas there was no statistically significant difference in the visual reaction time. The scores of the AMIPB-A and AMIPB-B were detected statistically higher after a month compared to admission. The score of the dominant hand FTT after a month was detected statistically higher than that in admission whereas there was no statistically significant difference in the non-dominant hand score. Conclusion: Improvements in scores of AMIP-A, AMIP-B, FTT and auditory reaction time after one month of quitting cannabis suggest that cannabis use may impair cognitive functions such as information processing, reaction time and motor functions. We suggest that future studies to assess cognitive functions after either a shorter (i.e. 1 week) or a longer (i.e. 2 months) period of cannabis abstinence in larger samples may provide further useful data about the relationship between cannabis use and cognitive functions.

Düşünen Adam, Sep 15, 2012

Mental symptoms are related with impact of the disease and impairment in quality of life in femal... more Mental symptoms are related with impact of the disease and impairment in quality of life in female patients with fibromyalgia Objective: Diagnostic criteria of fibromyalgia are revised in 2010 by including mental symptoms and excluding tender points. Although dominance of pain still prevails on the diagnostic criteria, quality of life (QoL) surveys showed that fibromyalgia is strongly associated with mental components of health status, i.e. depression, anxiety and alexithymia. It is aimed to assess determinants of QoL and impact of the disease in patients with fibromyalgia. Methods: Fifty seven female outpatients (mean age±SD: 40.93±6.85; age range: 24-56) with fibromyalgia were enrolled. Fibromyalgia Impact Questionnaire, Short Form-36 QoL survey, Beck Depression Inventory, State-Trait Anxiety Inventory, 20-item Toronto Alexithymia Scale were the measurement tools. Results: Predictor of impact of the disease was alexithymia, particularly, difficulty in identifying feelings (DIF) domain. Predictor of physical health was age, whereas predictors of mental health were depression and trait anxiety. Discussion: Alexithymia, particularly DIF domain may be a more specific predictor of fibromyalgia symptoms, whereas depression and anxiety are more burdensome mental symptoms for fibromyalgia. Pain and mental symptoms are seemed to be processed separately. Targeting mental symptoms may provide better treatment outcomes, thus multidisciplinary approaches including psychiatry are necessary.

Ankara Medical Journal, 2015

Objectives: According to the common view, there is no adequate information in psychiatry literatu... more Objectives: According to the common view, there is no adequate information in psychiatry literature about the connection between on one side "anxiety sensitivity" indicating an intrinsic anxiety tendency or a personality trait and on the other side suicide. This study is planned based on the hypothesis whether higher anxiety sensitivity is a preventive factor in terms of suicide. Materials and Methods : The study comprises of two groups: one consisting of 31 patients with unipolar depression diagnosis according to DSM-IV-TR, who have never attempted and still had no thought of suicide and the other consisting of 28 patients resorted to Ankara Atatürk Training and Research Hospital psychiatry outpatient department or Ankara Atatürk Training and Research Hospital emergency service upon attempting suicide. Anxiety Sensitivity Index-3 (ASI), Suicide Probability Scale (SPS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) are conducted for the patients after receiving their informed consents. In addition, three sub-scales of Anxiety Sensitivity Index-3-social, cognitive and physical-are investigated with individual scoring. Results: There were 28 patients in the depression group with suicide history (group 1) and 31 patients in the depression group without suicide history (group 2). No difference associated with age, education, gender and marital status is detected. The difference with respect to total point of anxiety sensitivity index (Mgroup1 = 27.2 ± 16.9, Mgroup2 = 35.9 ± 15.2, t = 2.045, p = 0.045), scores of "physical" sub-scale (Mdngroup1 = 5.5, Mdngroup2 = 10, Z =-1.989, p = 0.047) and total points of Beck Depression Inventory between groups is considered significant. No statistically significant intergroup difference is detected in total points of ASI-3's social and cognitive sub-scales, BAI and SPS. Conclusion: As ASI-3 is a scale measurable in a short time for evaluating the suicide risk in depression patients, it can be suggested hereby that ASI-3 can be helpful for clinical use.

The European Research Journal, 2015

Turkish Journal of Psychiatry, 2014

Delusional misidentification syndrome develops in conjunction with other psychiatric and neurolog... more Delusional misidentification syndrome develops in conjunction with other psychiatric and neurologic diseases, and is characterized by an individual's belief that the identity of a person, place, object, or event has somehow been replaced or altered (Bilici et al. 2011). We present an interesting case that represents a novel presentation of delusional misidentification syndrome.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2011

Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine... more Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine the frequency of psychiatric morbidity in vitiligo patients treated at the dermatology outpatient clinic and to investigate the relation between anxiety, depression, social anxiety levels, and self esteem and disability in these patients. Method: Fourty-two patients with vitiligo were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), Liebowitz Social Anxiety Scale (LSAS) and Sheehan Disability Scale (SDS). Control group included subjects matched to patients in terms of age, sex and education level. Results: In comparison to healthy controls, the rate of psychiatric morbidity was found to be higher and mean self-esteem score was found to be lower in the vitiligo group. There was no significant difference between groups in terms of social anxiety. Majority of the patients were mildly disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in female and young participants. Anxiety and social avoidance scores negatively correlated with age. Conclusion: These findings suggest that the rate of psychiatric morbidity is higher in patients with vitiligo than healthy control subjects. Patients with vitiligo treated at dermatology clinics should be assessed in terms of psychiatric disorders and psychiatric interventions may become necessary in the course of illness.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıl... more Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıldır şizofreni tedavisinde kullanılmaktadır ve kayda değer yan etkileri bulunmasına rağmen, tedaviye dirençli şizofrenide halen altın standarttır. Klozapin tedavisi sırasında sık karşılaşılan ve hastaların yaşam kalitesini önemli düzeyde etkileyebilen bir yan etki de siyaloredir. Klozapinin belirgin antikolinerjik yan etkilerine karşın, halen hangi mekanizmayla siyaloreye neden olduğu net biçimde bilinmemektedir. Sık karşılaşılmasına ve yaşam kalitesini belirgin biçimde etkileyebilmesine rağmen, siyalorenin tedavisinde halen mevcut seçeneklerin başarı oranı kısıtlıdır. Bu yazıda, klozapine bağlı gelişen siyalorenin patofizyolojisi ve tedavi seçenekleri güncel bilgiler ışığında gözden geçirilmiştir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha ç... more Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha çok şizofreninin bir alt grubu olarak değerlendirilmiş olsa da, birçok genel tıbbi durum, nörolojik hastalık ya da bazı ilaçlara bağlı olarak da ortaya çıkabilir. Disülfiram, alkol bağımlılığı tedavisinde caydırıcı etkisi nedeniyle kullanılabilen bir ajandır. Psikoz ve deliryum gibi nöropsikiyatrik yan etkilere neden olabilir. Katatonik sendrom disülfiramın çok nadir görülen bir yan etkisidir. Bu yazıda, kliniği bilişsel işlevlerde bozulma ile başlayan ve katatonik sendroma dönüşen bir vaka sunulmaktadır. Hastanın alkol kötüye kullanımı dışında psikiyatrik öyküsü yoktu ve son 1 aydır, reçetesiz temin ettiği disülfiramı kullanıyordu. Hastaya, disülfirama bağlı katatoni tanısı ile elektrokonvülsif tedavi uygulandı. Tam düzelme sağlanan ve ilaçsız izlenen vakanın iyilik hali devam etti. Bu çalışmada, örnek vaka çerçevesinde katatoni kavramı tartışılmaktadır.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıl... more Klozapine bağlı siyalorenin patofizyolojisi ve güncel tedavi seçenekleri Klozapin yaklaşık 40 yıldır şizofreni tedavisinde kullanılmaktadır ve kayda değer yan etkileri bulunmasına rağmen, tedaviye dirençli şizofrenide halen altın standarttır. Klozapin tedavisi sırasında sık karşılaşılan ve hastaların yaşam kalitesini önemli düzeyde etkileyebilen bir yan etki de siyaloredir. Klozapinin belirgin antikolinerjik yan etkilerine karşın, halen hangi mekanizmayla siyaloreye neden olduğu net biçimde bilinmemektedir. Sık karşılaşılmasına ve yaşam kalitesini belirgin biçimde etkileyebilmesine rağmen, siyalorenin tedavisinde halen mevcut seçeneklerin başarı oranı kısıtlıdır. Bu yazıda, klozapine bağlı gelişen siyalorenin patofizyolojisi ve tedavi seçenekleri güncel bilgiler ışığında gözden geçirilmiştir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha ç... more Disülfirama bağlı olarak gelişen bir katatoni olgusu Katatoni, sınıflandırma sistemlerinde daha çok şizofreninin bir alt grubu olarak değerlendirilmiş olsa da, birçok genel tıbbi durum, nörolojik hastalık ya da bazı ilaçlara bağlı olarak da ortaya çıkabilir. Disülfiram, alkol bağımlılığı tedavisinde caydırıcı etkisi nedeniyle kullanılabilen bir ajandır. Psikoz ve deliryum gibi nöropsikiyatrik yan etkilere neden olabilir. Katatonik sendrom disülfiramın çok nadir görülen bir yan etkisidir. Bu yazıda, kliniği bilişsel işlevlerde bozulma ile başlayan ve katatonik sendroma dönüşen bir vaka sunulmaktadır. Hastanın alkol kötüye kullanımı dışında psikiyatrik öyküsü yoktu ve son 1 aydır, reçetesiz temin ettiği disülfiramı kullanıyordu. Hastaya, disülfirama bağlı katatoni tanısı ile elektrokonvülsif tedavi uygulandı. Tam düzelme sağlanan ve ilaçsız izlenen vakanın iyilik hali devam etti. Bu çalışmada, örnek vaka çerçevesinde katatoni kavramı tartışılmaktadır.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Mental symptoms are related with impact of the disease and impairment in quality of life in femal... more Mental symptoms are related with impact of the disease and impairment in quality of life in female patients with fibromyalgia Objective: Diagnostic criteria of fibromyalgia are revised in 2010 by including mental symptoms and excluding tender points. Although dominance of pain still prevails on the diagnostic criteria, quality of life (QoL) surveys showed that fibromyalgia is strongly associated with mental components of health status, i.e. depression, anxiety and alexithymia. It is aimed to assess determinants of QoL and impact of the disease in patients with fibromyalgia. Methods: Fifty seven female outpatients (mean age±SD: 40.93±6.85; age range: 24-56) with fibromyalgia were enrolled. Fibromyalgia Impact Questionnaire, Short Form-36 QoL survey, Beck Depression Inventory, State-Trait Anxiety Inventory, 20-item Toronto Alexithymia Scale were the measurement tools. Results: Predictor of impact of the disease was alexithymia, particularly, difficulty in identifying feelings (DIF) domain. Predictor of physical health was age, whereas predictors of mental health were depression and trait anxiety. Discussion: Alexithymia, particularly DIF domain may be a more specific predictor of fibromyalgia symptoms, whereas depression and anxiety are more burdensome mental symptoms for fibromyalgia. Pain and mental symptoms are seemed to be processed separately. Targeting mental symptoms may provide better treatment outcomes, thus multidisciplinary approaches including psychiatry are necessary.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotip... more İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotipler Bilişsel işlev bozuklukları iki uçlu bozukluğun klinik düzelme dönemlerinde dahi hastaları etkilemektedir. Başta sözel öğrenme, sözel bellek ve yürütücü işlev bozuklukları olmak üzere faal bellek, dikkat, dikkati sürdürme ve işlem hızı iki uçlu bozuklukta öne çıkan alt bilişsel alanlardır. Sözel öğrenme ve sözel bellek hastaların yanında birinci derece akrabalarda da en fazla etkilenmiş işlevler olduklarından hastalıkla ilgili bir özellik olabilir, dolayısıyla bilişsel ara fenotip kavramına en uygun aday gibi görünmektedirler. Psikotik hastalık dönemlerinin olup olmaması, geçirilen hastalık dönemi tip ve sayıları, hastalığın başlangıç yaşı ve hastalık süresi bilişsel kayıpları etkilediği belirlenmiş klinik parametrelerdir. İki uçlu bozuklukların erken başlangıçlı formları, tip II bozukluk, yaşlılık ve komorbidite varlığı durumlarında bilişsel işlevlerin nasıl etkilendiği ile ilgili sınırlı sayıda araştırma bulunmaktadır. Ayrıca ilaçların bilişsel işlevleri kalitatif ve kantitatif olarak nasıl etkilediği ile ilgili yeterli ve tutarlı kanıt bulunmamaktadır. Hastaların birinci derece akrabalarında bilişsel kayıpların görülmesi ve kayıpların ailesel benzerlik göstermesi bilişsel işlevler için kalıtım göstergesi olabilir, bu nedenle araştırmaların desenlenmesinde genetik modellerin dikkate alınması önemli veriler sağlayabilir.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2012

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bi... more Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder Objective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians' attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64±10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications.

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2010

İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotip... more İki uçlu bozuklukta bilişsel işlev bozukluklarının klinik belirleyicileri ve bilişsel ara fenotipler Bilişsel işlev bozuklukları iki uçlu bozukluğun klinik düzelme dönemlerinde dahi hastaları etkilemektedir. Başta sözel öğrenme, sözel bellek ve yürütücü işlev bozuklukları olmak üzere faal bellek, dikkat, dikkati sürdürme ve işlem hızı iki uçlu bozuklukta öne çıkan alt bilişsel alanlardır. Sözel öğrenme ve sözel bellek hastaların yanında birinci derece akrabalarda da en fazla etkilenmiş işlevler olduklarından hastalıkla ilgili bir özellik olabilir, dolayısıyla bilişsel ara fenotip kavramına en uygun aday gibi görünmektedirler. Psikotik hastalık dönemlerinin olup olmaması, geçirilen hastalık dönemi tip ve sayıları, hastalığın başlangıç yaşı ve hastalık süresi bilişsel kayıpları etkilediği belirlenmiş klinik parametrelerdir. İki uçlu bozuklukların erken başlangıçlı formları, tip II bozukluk, yaşlılık ve komorbidite varlığı durumlarında bilişsel işlevlerin nasıl etkilendiği ile ilgili sınırlı sayıda araştırma bulunmaktadır. Ayrıca ilaçların bilişsel işlevleri kalitatif ve kantitatif olarak nasıl etkilediği ile ilgili yeterli ve tutarlı kanıt bulunmamaktadır. Hastaların birinci derece akrabalarında bilişsel kayıpların görülmesi ve kayıpların ailesel benzerlik göstermesi bilişsel işlevler için kalıtım göstergesi olabilir, bu nedenle araştırmaların desenlenmesinde genetik modellerin dikkate alınması önemli veriler sağlayabilir.