Skin Picking Disorder

Skin picking disorder is not a dermatological disorder and it is a table characterized with picking skin excessively and repetitively, leading to damage in skin tissue. Unlike normal picking behaviour, psychogenic skin picking is repetitive and it can lead to severe damage in the skin and even complications which constitute vital danger. While some patients define frequent but short lasting picking attacks, others define rarer attacks which last a few hours. Skin picking disorder, which is not included in the classification systems up to DSM-5 as a separate diagnosis category, is included as an independent diagnosis in Obsessive Compulsive Disorder and Associated Disorders category in DSM-5. In case reports, open label studies and double blind studies selective serotonin reuptake inhibitors are shown to be effective in the treatment of skin picking disorder. Mostly, cognitive-behaviourial techniques are used and have been proven to be useful in psychotherapy. Habit reversal is one of the behaviourial techniques which are frequently applied, give positive results in which well-being state can be maintained. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(4.000): 401-428

Memory deficits and frontal lobe syndrome associated with bilateral globus pallidus lesions in a patient with synthetic cannabinoid use

Major strategic functions of the basal ganglia are thought to involve the fine tuning and modulation of the activity of the most parts of the frontal cortex, control of the skeleto-motor and oculo-motor movements, and modulation of the limbic system and associative functions. In this case report, a patient with a 10-year history of synthetic cannabinoid use and bilateral symmetrical hyperintense lesions of the globus pallidus in T2 weighed images following head trauma is described in conjunction clinical signs of global amnesia, behavioral changes consistent with frontal lobe syndrome, and reduced affect display, without any movement disorders. To the best of our knowledge, this patients represents the first case who had bilateral globus pallidus lesions due to synthetic cannabinoid use together with frontal lobe syndrome-like clinical signs without movement disorder. This case report points out to the fact that synthetic cannabinoid use may lead to development of bilateral globus pallidus lesions, which may be associated with amnesia without movement disorder, suggesting that this clinical picture may have resulted from the interruption of pathways between the prefrontal cortex and basal ganglia

Effect of monoamine oxidase B A644G variant on nicotine dependence and/or schizophrenia risk

Objectives: Schizophrenia (Sch) is a severe and chronic mental illness. Smoking prevalence is higher in patients with Sch than general population. We aimed to investigate the effects of MAOB gene A644G variant on nicotine dependence (ND) and Sch+ND risk in Turkish population and to evaluate by bioinformatic analysis. Methods: Present study included 161 individuals with ND, 223 patients with Sch+ND, and 96 non-smoker controls. MAOB A644G variant was analyzed using PCR-RFLP method. As the MAOB gene is located on the X chromosome, each gender was analysed separately. Results: The total distributions of AA, AG and GG genotypes of MAOB gene A644G were 44.7%, 22.4% and 32.9% in the ND group, 45.3%, 25.1% and 29.6% in the Sch+ND group and, 44.8, 22.9% and 32.3% in non-smoker controls. No significant differences were observed between groups for the MAOB A644G genotype and allele frequencies when female group compared to male group (p > 0.05). Examination of disease associations of SNPs from each miRNA gene region in GWAS databases yielded results for aging, bipolar disorder, autoimmune, and neurological diseases. Discussion: Our results indicate that the MAOB gene A644G variant is not associated with ND and/or Sch susceptibility in the Turkish population

XRCC4 rs6869366 polymorphism is associated with susceptibility to both nicotine dependence and/or schizophrenia

Background: Oxidative stress induced DNA damage has been assumed to contribute to the etiopathogenesis of schizophrenia (Sch). Smoking prevalence was more common in patients with Sch. The X-ray repair cross-complementation group 4 (XRCC4) gene plays an important role in the repair of DNA double-strand breaks. Objective: The purpose of this study was to investigate whether XRCC4 rs6869366 polymorphism has a relationship both in nicotine dependence (ND) and Sch+ND risk. Methods: One hundred and four patients with Sch+ND, 133 subjects with ND only and 70 healthy controls were enrolled in the study. XRCC4 rs6869366 polymorphism was analyzed using PCR-RFLP assay. Results: The frequency of XRCC4 rs6869366 GG genotype was more common in the ND and Sch+ND group than controls (p = 0.001 and p = 0.001, respectively). XRCC4 rs6869366 TT genotype was lower in both ND and Sch+ND group compared to controls (p = 0.001 and p = 0.001, respectively). Also, XRCC4 rs6869366 G allele was higher in Sch+ND group than controls (p = 0.001) while XRCC4 rs6869366 T allele was lower in ND group than healthy controls (p=0.001). XRCC4 rs6869366 GT genotype was lower in ND group than control group (p = 0.003). Discussion: These results suggested that the XRCC4 rs6869366 polymorphism G related genotype/allele was associated with susceptibility to both ND and Sch+ND in a Turkish population

Rediscovery of penicillin of psychiatry: haloperidol decanoate

BACKGROUND: Haloperidol has been used as an effective antipsychotic for many years and continues to be one of the first options in difficult patients who require parenteral therapy in the acute phase. However, the depot form is less preferred in the treatment of patients with non-adherence among these patients whose clinical stabilization has been achieved by using parenteral haloperidol in the acute phase. Therefore, updating the information about the side effects of the depot form of haloperidol, which is still an effective treatment option, will be useful in reconsidering the position of this medicine among new and different options. METHODS: A total of 54 schizophrenic patients with severe symptoms and poor adherence to treatment who were hospitalized and treated with depot haloperidol following an acute stabilization period were included in this study. First, the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-CV) was used to confirm the diagnosis, the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) to assess the clinical severity and Global Assessment of Functioning (GAF) to assess the functionality. The Simpson-Angus Scale (SAS) was used to assess extrapyramidal side effects. With the exception of Visit 0, plasma haloperidol levels were measured at all visits. Also, measurements of waist circumference and weight, plasma fasting blood glucose, triglyceride, HDL, iron, haemoglobin (Hgb), prolactin (PRL) and HbA1c were also used for evaluation of the metabolic effects. RESULTS: Significant improvements were observed in the BPRS, SANS, SAPS scores in the long-term follow-up with the depot haloperidol treatment. While the dosage decreased over time, the plasma levels remained changed, and symptom improvement was maintained. No signs such as neuroleptic malignant syndrome or acute dystonia were observed and SAS scores were within acceptable limits during the treatment (mu = 1.40 +/- 2.55). There is no statistically significant difference between measurements of the weight even there was a significant difference between three of the waist circumference values (p = 0.987). The first measurement of the waist circumference is statistically significantly higher than both the mid-measurement and the final measurement, interestingly (p = 0.002). When fasting blood glucose, triglyceride, HDL, iron, Hgb, PRL and HbA1c were measured at different times throughout the study, only prolactin levels increased significantly over time with the use of haloperidol (p < 0.001). At the end of a year, 50% of the patients participating in the study still continued to use the haloperidol decanoate. This means also that half of the patients had stopped to use haloperidol decanoate. However, only 18.5% of them (n = 5) discontinued use of this drug because of extrapyramidal side effects. CONCLUSION: Depot haloperidol remains an effective treatment option that improves treatment compliance in challenging schizophrenia patients with severe symptoms. The long-term metabolic and extrapyramidal side effect profile of the patients were generally within the safe limits with the use of haloperidol depot. According to the obtained data, the depot haloperidol continues to be a reliable treatment option in terms of adverse effects in the maintenance treatment of schizophrenia patients with severe symptoms and poor adherence to treatment

Antiepileptic Drugs in the Treatment of Anxiety Disorders

In addition to epilepsy, antiepileptic drugs are used in neurologic conditions such as chronic pain and in the treatment of bipolar disorder in psychiatry. There are studies reporting its use in the treatment of anxiety disorders. The efficacy of antiepileptic drugs as carbamazepine, valproic asid, lamotrigine, topiramate, gabapentin, pregabalin in anxiety disorders has been shown in some clinical studies. The strongest evidence has been presented for pregabalin in generalized anxiety disorder, pregabalin and gabapentin in social anxiety disorder and lamotrigine in posttraumatic stres disorder. While certain studies report the effectiveness of antiepileptic drugs in the treatment of anxiety disordes, others report them as ineffective. Double blind placebo controlled drug trials are essential for clearly presenting anxiolytic activity of antiepileptic drugs which would lead the way to further wide scale use in clinical practice. This article focuses on recent literature to show the potential use of antiepileptic drugs in patients suffering from generalized anxiety disorder, social anxiety disorder, posttraumatic stres disorder, panic disorder along with a brief review of neuroanatomic structures and neurotransmitters associated with epilepsy and anxiety disorders

Polysubstance use disorder as a probable self-medication in Isaacs’ syndrome

Isaacs’ syndrome (IS) is an autoimmunological hyperexcitability syndrome of the peripheral motor nerves, manifesting with progressive muscle stiffness, involuntary continuous muscle twitching, muscle pain and cramping, sweating, and decreased reflexes. We report a 31-year-old man who was suffering from muscle twitches and stiffness in lower extremities and previously diagnosed with IS in his age of 16 through electrophysiological studies and the shown presence of autoantibodies against voltage-gated potassium channels. Without any adherence to the prescribed treatment, he had been using synthetic cannabinoids and opioids for 10 years. He admitted lessened complaints by using them. Current literature offered cannabinoid receptor agonists not only for symptomatic relief in IS, but also potential modulator effects on both potassium channels and autoimmunity. Opioids were also recognized with their analgesic and antispastic effects in the management of IS. This report aimed to discuss possible medicinal effects and therapeutic mechanisms of aforementioned psychoactive molecules on the symptomatology of IS

Detection of altered methylation of MB-COMT promotor and DRD2 gene in cannabinoid or synthetic cannabinoid use disorder regarding gene variants and clinical parameters.

This study aims to investigate the association between cannabinoid use disorder (CUD) or synthetic cannabinoid use disorder (SCUD) and methylation status of MB-COMT (membrane-bound catechol-O-methyltransferase) promotor or DRD2 gene considering gene variants and clinical parameters. Based on the DSM-5 criteria, 218 CUD/SCUD patients' diagnoses were confirmed with a positive urine test, and a control group consisting of 102 participants without substance use disorders was included. Methylation-specific PCR was used to identify the methylation of the MB-COMT promotor and DRD2 gene. DRD2-141C Ins/Del and COMT Val158Met gene variants were evaluated by using PCR-RFLP. When the DRD2 and MB-COMT promoter methylation of CUD/SCUD patients were compared with the control group, there was a significant difference between the MB-COMT promoter methylation status of the two groups. When comparing DRD2 gene methylation due to clinical parameters and DRD2 genotype distribution in patients, the methylation status was significantly different between the groups due to the family history. Again, comparing the MB-COMT promotor methylation due to the COMT Val158Met genotype distribution and clinical parameters in patients, the MB-COMT promoter methylation status was significantly different between the groups due to the presence of alcohol usage. In summary, whereas the MB-COMT promoter methylation may be associated with the CUD/SCUD, the methylation of the DRD2 gene was not related to CUD/SCUD

UCP2 and CFH Gene Variants with Genetic Susceptibility to Schizophre-nia in Turkish Population

Objective: Schizophrenia (Sch) is a complex, multifactorial psychiatric disorder. Growing evidence shows that oxidative damage and immunological dysfunction exist in the Sch physiopathology. In the present study, we aimed to evaluate whether the Uncoupling protein 2 and Complement factor H gene variants play any role in susceptibility to Sch. Methods: This study was carried out on 200 individuals (100 Sch patients and 100 healthy controls). Genomic DNA was extracted from blood samples. UCP2-866G /A (rs659366) and CFHY402H variants were analyzed by PCR-RFLP analysis. Results: The UCP2-866G/A variant G/G genotype and G allele were associated significantly with increased risk of Sch (p=0.001, p=0.001, respectively). The subjects were carrying UCP2-866G/A variant G/G genotype had 4.377-fold increased risk for Sch. There was no significant difference between the groups for the genotype and allele frequencies of the CFH Y402H variant (p>0.05). The observed genotype counts deviated significantly from those expected in Sch patients according to the HWE for UCP2-866G/A variant (p=0.001). Conclusion: We present the first results investigating UCP2-866G/A/ and CFH Y402H variants for susceptibility to Sch in a Turkish population. These results indicate that the UCP2 -866G/A, but not CFHY402H variant, might play an important role in the development of Sch

Association of the Uncoupling Protein 2-866 G/A Polymorphism with Family History and Duration of Tobacco Use Disorder in a Turkish Population

Background: A variety of substances cause neurotoxicity by increasing intracellular oxidative stress, followed by mitochondrial dysfunction. Uncoupling proteins (UCPs) act as membrane transport proteins and reduce reactive oxygen products and mitochondrial calcium influx. We aimed to study UCP2-866 G/A gene polymorphism in tobacco use disorder (TUD) by comparing genotype distributions between TUD patients and healthy controls considering clinical parameters