The association between the clinical and therapeutic features and the course of the illness in patients with Bipolar-I disorder treated in Selçuk University Medical Faculty Psychiatry department

Bu çalışmada, kliniğimizde takipleri devam eden Bipolar-I bozukluklu hastaların sosyodemografik, tedavi ve klinik özellikleri, hastalığın başlangıç belirtileri, tanısal sorunlar ve bunların hastalığın seyrine olan etkileri araştırılmıştır.Yöntem: Çalışmamıza Selçuk Üniversitesi Meram Tıp Fakültesi Psikiyatri Polikliniğinde, DSM IV- TR Tanı Ölçütlerine göre BP-I bozukluk tanısı almış olan 18 yaşından büyük, en az 5 yıldır düzenli takibi yapılan hastalardan verileri yeterli görülen ardışık 179'u dahil edilmiştir. Hastaların sosyodemografik, tedavi ve klinik özellikleri, 5 yıllık klinik seyirleriyle birlikte anksiyete ve alkol-madde kullanım bozukluğu araştırılmıştır.Bulgula: 179 Bipolar-I bozukluklu hastanın 121'ine (%67.6) başlangıçta farklı tanılar (%34.1 depresyon, %24.0 şizofreni, %9.5 diğer psikiyatrik bozukluklar) konulduğu, ortalama 6.3±7.4 yıl gecikmeyle BP-I tanısı konularak duygudurum düzenleyici ilaçların kullanılmaya başlandığı bulundu. Son 5 yıl içerisindeki ortalama atak sayısı değerlendirildiğinde; manik atak sayısı 1.67±1.52, depresif atak sayısı 2.02±2.31, karma atak sayısı 0.88±1.18, hipomanik atak sayısı 0.18±0.60 ve toplam atak sayısı 4.79±4.11 olarak bulundu. Yıllık atak sıklığı 0.93±0.82 olarak bulunmuştur. Hastaların %24.7'sinde en az bir intihar girişimi öyküsü saptanmıştır. Anksiyete bozukluğu eştanısı alan hasta sayısı 58 (%32.4) iken, anksiyete bozuklukları içinde en sık obsesif kompulsif bozukluk (%16.2) saptanmıştır. Hastaların %29.1'i erken (18 yaşından önce) başlangıçlı ve %57'si psikotik özellikli olarak bulundu. Erken başlangıçlı BP-I bozukluk olgularında, diğerlerine göre evlilik oranları düşük ve daha fazla psikotik özellik saptandı. Psikotik özellikler, başlangıçta şizofreni tanısı alma ve doğru tanıya ulaşma süresinin daha fazla olmasına ve daha sık atak geçirmeyle ilişkili olduğu bulundu. Anksiyete bozukluğu eştanılı olmanın hastalığın seyrini ciddi ölçüde olumsuz etkilediği saptandı. Eşikaltı belirtilerin olması daha sık atak geçirme ile ilişkili bulundu. Çalışmamıza alınan hastalar son değerlendirmelerinde, %46.4'ü remisyonda, %21.9'u kısmi remisyonda, %16.2'si depresif dönemde (% 4.5'i psikotik özellikli), % 8.4'ü manik dönemde (%2.8'i psikotik özellikli), %5.6'sı karma dönemde ve %1.7'si hipomanik dönemdeydi.Sonuç: Bipolar-I bozukluklu hastalara, farklı klinik belirtilerinden dolayı yanlış tanılar konulabilmekte ve uygun tedavilerine başlanılması gecikebilmektedir. Geç tanı konulmasıyla birlikte, erken başlangıç, psikotik özellikli olma, anksiyete bozuklukları eştanısı olma ve eşik altı belirtilerin bulunması klinik seyri olumsuz etkileyebilmektedir.Our aim in this study was to evaluate socio-demographic, treatment and clinical features of BP-I disordered patients with initial symptoms of disorder and diagnostic problems and to determine the effects of these features on the course of disorder.Method: In total, 179 patients were included to the study. All patients with BP-I disorder were diagnosed according to DSM IV-TR criteria in our Psychiatry clinics. All patients included to the study were older than 18 and were monitored regularly. The patients? socio-demographic and clinical features were evaluated. Anxiety and substance abuse disorders of these patients were also evaluated along with 5 year course of disorder and each were recorded.Findings: In total 179 patients were included to the study. Of the 179 patients included to the study 121 ( 67.6%) of them with Bipolar-I disorder were misdiagnosed according to initial clinical symptoms (34.1% depression, 24.0% schizophrenia, 9.5% other psychiatric disorders). The avarage delay for these patients of mood stabilizer treatment protocol was 6.3±7.4 year. When average episodes within recent 5 years were considered; average manic episodes were 1.67±1.52, average depressive episodes were 2.02±2.31, average mixed episodes were 0.88±1.18, average hypomanic episodes were 0.18±0.60 and total average episodes were 4.79±4.11 in number. Frequency of episode for each year was calculated as 0.93±0.82 in number. In all patients 24.7% of them were found to have at least one suicide attempt. In those 121 patients 58 (32.4%) of them were having comorbid anxiety disorder. Twentynine of them (16.2%) were diagnosed with OCD, which was the most frequent anxiety disorder seen in our study group. Early age onset was seen in 29.1% of the patients and in total, 57% of the patients were showed psychotic features. In the patients with the initial start of the illness before 18 years old were less likely to be married and had more psychotic attacks. Psychotic identities caused more psychotic attacks and some difficulties in schizophrenia diagnosis. It is observed that anxiety disorder co-diagnosis worsly affected the patients? outcome. Having under-limit qualifications was a reason of frequent attacks. In the final assessment of the patients in the study, % 46.4 of them were in remission, %21.9 of them were in partial remission, % 16.2 of them were in depressive episode (%4.5 of them were psychotic), %8.4 of them were in manic episode (%2.8 of them were psychotic), %5.6 of them were in mixed episode and %1.7 of them were in hypomanic episode.Conclusion: Patient with bipolar-I disorders can be misdiagnosed and there might be a delay in the initial appropriate treatment. Delayed diagnose can effect the time of onset of psychotic bipolar disorder, the frequency of comorbid cases and subsyndromal symptoms

Lack of association of DRD3 and CNR1 polymorphisms with premenstrual dysphoric disorders

Background: Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical and affective symptoms during the luteal phase of susceptible women. Objective: The aim of this study was to investigate the association of Dopamine D3 receptor (DRD3) polymorphism, and Cannabinoid receptor Type 1 (CNR1) polymorphism with PMDD. Materials and Methods: Fifty one participants with documented PMDD according to the DSM IV criteria and 51 healthy controls were included in this cross sectional study. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews. The genotyping of DRD3 receptor and Cannabinoid type 1 receptors were performed using Taqmanfluorogenic assay method. Results: Distribution of DRD3 and CNR1 polymorphism was not different between patients and controls. Conclusion: These findings do not support a major role of DRD3, and CNR1 polymorphisms in contributing to susceptibility to premenstrual dysphoric disorder