Atypical antipsychotics in treatment of bipolar disorderin special populations

Atypical antipsychotics have increased usage during the last decades.While they were used in treatment resistant schizophrenia patients at thebeginning, they have gained widespread use in treatment of variouspsychiatric disorders including acute schizophrenia, bipolar disorder,psychotic depression, as a first-line or add-on treatment option.Life stages such as pregnancy and nursing, childhood and adolescence,old age have special impacts on the symptoms and prognosis ofdisorders as well as on the treatmant response and side-effects.Psychopharmacological studies have been more commonly conducted inadult populations due to increased awereness and importance of ethicalprinciples and implications, which restrict and even make impossible tostudy the effectiveness of a new agent on special populations.In this article, the use of currently used atypical antipsychotics in Turkeyincluding clozapine, risperidone, olanzapine, and quetiapine in specificpopulations in the treatment of bipolar disorder are reviewed and somepractical issues are represented

Heat transfer effects on the stability of low speed plane Couette-Poiseuille flow

The stability problem of low-speed plane Couette-Poiseuille flow of air under heat transfer effects is solved numerically using the linear stability theory. Stability equations obtained from two-dimensional equations of motion and their boundary conditions result in an eigenvalue problem that is solved using an efficient shoot-search technique. Variable fluid properties are accounted for both in the basic flow and the perturbation (stability) equations. A parametric study is performed in order to assess the roles of moving wall velocity and heat transfer. It is found that the moving wall velocity and the location of the critical layers play decisive roles in the instability mechanism. The flow becomes unconditionally stable whenever the moving wall velocity exceeds half of the maximum velocity in the channel. With wall heating and Mach number effects included, the flow is stabilized

Evaluation of repetitive transcranial magnetic stimulation for treatment-resistant major depression and the impact of anxiety symptoms on outcome

Objective: The aim of this study was to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with treatment-resistant major depression and to explore the relationship between the outcome and comorbid anxiety symptoms. Methods: The study was performed on 36 patients with treatment-resistant major depression. Patients received 15 rTMS sessions to their left dorsolateral prefrontal cortex with 110% motor threshold intensity, 20 Hz frequency, and 1000 pulses per day over a three-week period with the same stimulation parameters. Patients were assessed using Sociodemographics Form, the Montgomery–Asberg Depression Rating Scale (MADRS), and the Hamilton Anxiety Rating Scale (HAM-A) at baseline both before initiating rTMS treatment and on the first day following their last rTMS treatment session. Results: Decreased scores in patients’ MADRS and HAM-A (including subscales) were statistically significant with large effect sizes (r > 0.5) after rTMS treatment. Pretreatment HAM-A total scores and HAM-A somatic subscale scores were significantly higher in those who responded to rTMS (p = .046, p = .048). There were negative correlations between post-treatment MADRS scores and pretreatment HAM-A somatic and psychic subscale scores. Conclusions: While the main limitations of the study are its design and small sample size, the findings suggested that comorbid anxiety symptoms, particularly somatic anxiety, could predict the response to rTMS in treatment-resistant major depressive disorder

Assessment of health-related quality of life in Turkish patients with facial prostheses

Background: Facial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group

Alopecia associated with agomelatine use: a case report

Drug-induced alopecia, characterized by non-scarring hair loss of scalp and body, is a rare side effect of psychotropic drugs. It has previously been reported with the different antidepressant medications, but has not been described with agomelatine. Agomelatine is an antidepressant with a novel mechanism of action and fewer side effects. Here, we report a 31-year-old male patient with diffuse hair loss induced by agomelatine use and improved by discontinuation the drug. Because antidepressant-induced hair loss is relatively rare, many clinicians may not pay attention for this side effect. As far as we know, this is the first published case report of alopecia associated with agomelatine

Serum interleukin 1 alpha and interleukin 2 levels in patients with schizophrenia

It has been suggested that altered interleukin (IL) regulation may be involved in the pathogenesis of schizophrenia. In this cross-sectional, case-controlled study, patients with schizophrenia and a control group of healthy subjects, matched by age, sex and body mass index, were evaluated. The levels of IL-1alpha and IL-2 in blood serum were measured by enzyme-linked immunosorbent assay. The fasting serum IL-2 levels were significantly higher in patients with schizophrenia compared with the control subjects, but there was no difference between the fasting serum levels of IL-1alpha in patients with schizophrenia and the control subjects. Our results suggest that patients with schizophrenia have altered IL-2, but not IL-1alpha, regulation

Venlafaxine-induced prostatism: a case report

Venlafaxine, which is often used for a number of psychiatric-related conditions such as the treatment of major depression, generalized anxiety disorder, social anxiety disorder and panic disorder, is generally a drug that is well tolerated and safe. The side effects of drugs can cause the treatment to prematurely terminate. Clinicians should prefer appropriate and low side-effects drugs to prevent this. This situation is also especially important for psychiatric patients. Prostatism, which impairs quality of life, is an important medical condition, with clinical and social implications. In the previous studies, prostatism was declared as a side effect of some antidepressant such as milnacipran, duloxetine and reboxetine. In our case, we discussed that venlafaxine-related prostatism developed in a male patient. As far as we know this is the first report of venlafaxine-induced prostatism

Turkish patients with treatment-resistant schizophrenia

Background: Several lines of evidence suggest that clozapine is more effective than both first- and second-generation antipsychotic drugs in treatment-resistant schizophrenia (TRS). However, clinicians appear to be hesitant to prescribe this drug. it would therefore be extremely valuable if predictors of response to clozapine could be identified. The aim of this study was to evaluate the predictive factors of clinical responses to clozapine in a group of Turkish patients with TRS.Methods: This was a 16-week uncontrolled open study carried out among 97 TRS patients (80 males and 17 females; DSM-IV diagnosis). All patients fulfilled the criteria for refractory schizophrenia according to the UK guidelines for the National Institute of Clinical Excellence (NICE). After all previous antipsychotic medications had run their course, the patients were started on clozapine according to a standardized titration and dosage schedule. Psychopathology was evaluated before the initiation of clozapine therapy and once every 4 weeks using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment for Positive Symptoms, and the Scale for the Assessment of Negative Symptoms.Results: Of the TRS patients on clozapine, 55.7% achieved a clinical response, defined as at least a 20% decrease in BPRS. We observed a favorable effect of clozapine on both positive and negative symptoms. Logistic regression analysis showed that a good clozapine response was more likely when schizophrenia began at a later age, when negative symptoms were severe, and when patients had an early response at 4 weeks.Conclusion: A combination of demographic, baseline clinical, and acute treatment response variables may accurately predict response to clozapine in TRS. Priority should be given to initiating clozapine at the earliest phase of TRS, especially for patients with evident negative symptoms. (C) 2007 Elsevier Inc. All rights reserved

Efficacy and safety of amisulpride treatment in schizophrenia: comparison with haloperidol

Objective: Amisulpride is a novel atypical antipsychotic withpreferential affinity for presynaptic dopaminergic D2and D3receptors. There have been no clinical studies conducted withamisulpride in schizophrenia in Turkey. The aim of this open-labelstudy was to compare the efficacy and safety of amisulpride andhaloperidol in patients with schizophrenia.Methods: Forty patients with schizophrenia according to DSM-IVcriteria were included in the study. Patients were randomized to eitheramisulpride (n=20; 400-800 mg/d) or haloperidol (n=20; 15-30 mg/d)treatment. Positive and Negative Syndrome Scale (PANSS), BriefPsychiatric Rating Scale (BPRS), and Clinical Global Impressions (CGI)were used at days 0, 3, 7, 14, and 28 of treatment. Side effects wererecorded on UKU forms. Serum prolactin levels were measured atbaseline and at sixth week of treatment. Results: There were nosignificant differences in terms of improvement of PANSS, BPRS andCGI scores between the groups. While patients on amisulpride hadno acute dystonia (p=0.01), and had significantly milder parkinsonism(p<0.05), they had higher weight gain (p=0.001) and serum prolactinincrease (p=0.032). Conclusions: In this 6-week trial, amisulpride wasas efficacious as haloperidol in treatment of patients withschizophrenia. Extrapyramidal side effects were significantly lesscommon in the amisulpride grou