Altered Neurochemical Ingredient of Hippocampus in Patients with Bipolar Depression

Background. In a number of investigations, hippocampal neurochemicals were evaluated in the patients with bipolar disorder who were on their first episode or euthymic periods. However, we did not meet any investigation in which only patients with bipolar depression were examined. As a consequence, the objective of the present study was to examine both sides of hippocampus of patients with bipolar disorder in depressive episode and healthy controls using 1H-MRS. Methods. Thirteen patients with DSM-IV bipolar I disorder, most recent episode depressed, were recruited from the Department of Psychiatry at Firat University School of Medicine. We also studied 13 healthy comparison subjects who were without any DSM-IV Axis I disorders recruited from the hospital staff. The patients and controls underwent proton magnetic resonance spectroscopy (1H-MRS) of their hippocampus. NAA, CHO, and CRE values were measured. Results. No significant effect of diagnosis was observed for NAA/CRE ratio. For the NAA/CHO ratio, the ANCOVA with age, gender, and whole brain volume as covariates revealed that the patients with bipolar depression had significantly lower ratio compared to healthy control subjects for right and for left side. As for the CHO/CRE ratio, the difference was statistically significant for right side, with an effect diagnosis of F = 4.763, P = 0.038, and was very nearly significant for left side, with an effect diagnosis of F = 3.732, P = 0.064. Conclusions. We found that the patients with bipolar depression had lower NAA/CHO and higher CHO/CRE ratios compared to those of healthy control subjects. The findings of the present study also suggest that there may be a degenerative process concerning the hippocampus morphology in the patients with bipolar depression

Duloxetine-Induced Hypertension: A Case Report 2

SUMMARY Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is used for diabetic neuropathic pain and fibromyalgia as well as major depressive disorder. Serotoninnorepinephrine reuptake inhibitors may lead to increased blood pressure via their noradrenergic effects in addition to their cardiovascular side effects. In this paper, we report a case with increased blood pressure after the initiation of duloxetine that recovered by discontinuation of the medication

Diffusion-weighted MRI findings of caudate nucleus and putamen in patients with obsessive-compulsive disorder

Objective The purpose of this study was to establish the diffusion-weighted magnetic resonance imaging (DW-MRI) findings of the caudate nucleus and putamen in patients with obsessive-compulsive disorder (OCD) and to obtain new information on the etiopathogenesis of OCD, which is still unclear. Methods The study comprised 20 patients with OCDs and 20 healthy volunteers. In these cases, DW-MRI and diffusion-weighted echo-planar images (DW-EPI) at b600 and b1000 gradient values were taken and the measurements were made using the apparent diffusion coefficient (ADC) maps of each group at b600 and b1000 values from the caudate nucleus and putamen. Results When the DW-MRI examination in patients with OCD was compared with the control group, the mean ADC values in the caudate nucleus and putamen were not found to have statistically significantly changed. In addition, there were no significant differences regarding the right and left caudate nuclei and putamen ADC values at the b600 and b1000 in the patients with OCD or the control group. Conclusion There are still many unknowns about the neurobiology of OCD. When the DW-MRI examination of the patients with OCD was compared with the control group in our study, no significant difference was found between the ADC values of the caudate nucleus and putamen. Further studies are required for this present study on DW-MRI in patients with OCD to be meaningful

Urinary neopterine levels in patients with major depressive disorder: alterations after treatment with paroxetine and comparison with healthy controls

Background: A close relationship has been shown between mood disorders and pteridine levels. The aim of this study was to examine alterations in the urine neopterine levels of patients with major depressive disorder (MDD) who responded to paroxetine during the initial treatment and to compare their levels to those of healthy controls. Subjects and methods: Sixteen patients with major depression and 19 healthy controls were enrolled in the study. In order to assess depression severity levels, the Beck Depression Inventory, the Beck Anxiety Inventory, and the State-Trait Anxiety Inventory were administered. Urinary neopterine values that were measured using high pressure liquid chromatography (HPLC) were compared using non-parametric tests for the MDD patients before and after treatment. Urine neopterine levels in MDD patients before and after treatment were compared to those of the healthy control group. Results: Urinary neopterine levels were recorded as follows: For the MDD group before treatment the mean level was 187.92 +/- 54.79 mu mol/creatinine. The same group under treatment at 4 to 8 weeks was at 188.53 +/- 4962 mu mol/creatinine, and the healthy control group showed 150.57 +/- 152.98 mu mol/creatinine levels. There was no statistically significant difference in the urinary neopterine levels among the MDD patients before and after treatment (p=0.938). When urine neopterine levels in MDD patients before and after treatment were compared to those of the healthy control group, levels in the MDD group were found to be significantly higher (p=0.004 and p=0.005, respectively). Conclusions: Findings from the current study suggest that despite treatment response, depression is related to higher levels of urine neopterine. Paroxetine treatment has no significant effect on urine levels of neopterine in MDD patients

URINARY NEOPTERINE LEVELS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: ALTERATIONS AFTER TREATMENT WITH PAROXETINE AND COMPARISON WITH HEALTHY CONTROLS

Background: A close relationship has been shown between mood disorders and pteridine levels. The aim of this study was to examine alterations in the urine neopterine levels of patients with major depressive disorder (MDD) who responded to paroxetine during the initial treatment and to compare their levels to those of healthy controls. Subjects and methods: Sixteen patients with major depression and 19 healthy controls were enrolled in the study. In order to assess depression severity levels, the Beck Depression Inventory, the Beck Anxiety Inventory, and the State-Trait Anxiety Inventory were administered. Urinary neopterine values that were measured using high pressure liquid chromatography (HPLC) were compared using non-parametric tests for the MDD patients before and after treatment. Urine neopterine levels in MDD patients before and after treatment were compared to those of the healthy control group. Results: Urinary neopterine levels were recorded as follows: For the MDD group before treatment the mean level was 187.92±54.79 μmol/creatinine. The same group under treatment at 4 to 8 weeks was at 188.53±4962 μmol/creatinine, and the healthy control group showed 150.57±152.98 μmol/creatinine levels. There was no statistically significant difference in the urinary neopterine levels among the MDD patients before and after treatment (p=0.938). When urine neopterine levels in MDD patients before and after treatment were compared to those of the healthy control group, levels in the MDD group were found to be significantly higher (p=0.004 and p=0.005, respectively). Conclusions: Findings from the current study suggest that despite treatment response, depression is related to higher levels of urine neopterine. Paroxetine treatment has no significant effect on urine levels of neopterine in MDD patients

Do Defense Styles of Ego Relate to Volumes of Orbito-Frontal Cortex in Patients with Obsessive-Compulsive Disorder?

Objective Although the importance of orbito-frontal cortex (OFC) is established in the pathogenesis of obsessive compulsive disorder (OCD), no study have evaluated its relation to the traditional psychodynamic perspective. In the present study, we aimed to evaluate the relationship between the defense styles consisting of mature, immature and neurotic defenses and OFC volumes of patients with OCD. Methods Subjects were selected among those of our previous study, and so eighteen patients with OCD and same number of healthy controls were took into the study. The patients and controls had underwent magnetic resonance imaging (MRI). In addition, the Defense Style Questionnaire-40 was administered to obtain defense styles of patients and controls. Results No significant relationship was found between the right OFC volumes of both the patient and control groups and their scores of mature, neurotic, or immature defense mechanisms. As for the left OFC volumes, the only significant relationship for the scores of immature defense mechanism was found in the patient group. Conclusion The results of the present study indicated that there was no significant relationship between OFC volumes of the patient group and their scores of mature, neurotic, or immature defense mechanisms, except a significant relation with the scores of immature defense mechanisms.PubMedWoSScopu

Misdiagnosis of Bipolar Disorder: Rare or Frequent?

Background: As much there have been limited number of studies which have examined misdiagnosis of bipolar disorder, it is so difficult to say that there are enough systematic research to identify the diagnostic rate of bipolar disorder. On the other hand, we did not find any research in Turkey. For this reason, we wondered what is situation in our country in terms of misdiagnosis of bipolar disorder. Methods: The present study was done at xxx University, School of Medicine, Department of Psychiatry. Patients who were from both out-patient and in-patient clinics were included in the study. After a selection process, 171 patients with bipolar disorder were enrolled. In this group of patients, misdiagnosis of bipolar disorder were investigated. Results: 56.14 percent of patients had misdiagnosis of bipolar disorder. The most frequent misdiagnosis was fetermined to be major depressive disorder (in fifty cases, 54.3%). Followings were schizoaffective disorder (in eighteen cases, 24.3%), schizophrenia (in thirteen patients, 24.3%), delusional disorder (in thirteen patients, 24.3%), dysthymic disorder (in ten cases, 15.9%), generalized anxiety disorder ((in ten cases, 15.9%), obsessive compulsive disorder (in seven cases, 12.6%), paranoid personality disorder (in two cases, 4.1%). Conclusions: The results of the study suggest that bipolar disorder is frequently misdiagnosed one and that the most frequent misdagnoses were majör depressive disorder and following psychotic spectrum disorders. Clinicians should be aware of frequent misdiagnosis in patients with bipolar disorder

Mirtazapine Augmentation for Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: A Retropective Investigation

The aim of the present study was to retrospectively identify sexual dysfunction changes in the patients under mirtazapine-augmented serotonin reuptake inhibito (SSRI) treatment. The study comprised medical records of 20 outpatients, under mirtazapine-augmented SSRI treatment for their major depressive disorder, who had been selected among the patients that had developed sexual dysfunction to previous treatment as monotherapy, with SSRI for at least six weeks. These drugs were maintained and mirtazapine were added (15-45 mg/day). There was a significant difference in scores between baseline and week 4 or week 8 on the both Hamilton Depression Rating and Arizona Sexual Experience Scale. According to Clinical Global Impression-Improvement, 68.4% of the patients were responders. The use of low-dose mirtazapine as an add-on treatment to SSRIs appears to be an effective and well-tolerated augmenttaion for sexual dysfunction caused by SSRIs