Sexual functions and prolactin levels in patients with bipolar disorder

Objective: Mood stabilizers and antipsychotic drugs are known to have adverse effects on sexual function. However, patients often refrain from speaking about sexual complaints that may cause dose reduction and discontinuation of the drug without medical supervision. In this study we aimed to evaluate sexual functions of patients with bipolar disorder in remission period, considering prolactin levels and medications. Method: We recruited 52 patients with bipolar disorder in remission according to DSM-IV diagnostic criteria. Prolactin levels were measured in all patients. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was used to assess sexual dysfunction. Results: Mean prolactin levels were 24.71 ± 4.25 and 19.96 ± 5.52 ng/ml respectively for females and males. Patients taking mood stabilizer (MS) and mood stabilizer plus antipsychotic (AP) treatment had different prolactin levels (p<0.001). Total GRISS scores were not different for MS and MS+AP treatment groups. We didn't find a correlation between Total GRISS scores and prolactin levels. There was a significant deterioration in female non-sensuality, female dissatisfaction and anorgasmia subscales of female patients and significant deterioration in premature ejaculation, impotence and male dissatisfaction subscales of male patients. Discussion: In our sample, both men and women patients with bipolar disorder in remission have sexual dysfunctions. Our results suggest that prolactin levels are not sufficient to demonstrate the sexual dysfunction. To enhance patient compliance it is necessary to focus more on sexual symptoms of patients receiving MS and AP treatment

Increased serum dehydroepiandrosterone sulfate in the first episode but not in subsequent episodes in male patients with schizophrenia

Background: Many studies have investigated the relationship between blood levels of dehydroepiandrosterone (DHEA) and its sulfate ester (DHEA-S), cortisol, progesterone, and testosterone and the onset, prognosis, symptom severity, and treatment response of schizophrenia. In the present study, we assessed potential differences in blood levels of neurosteroids between drug-naive first-episode patients with schizophrenia (FES), and drug-free patients with schizophrenia who were not in the first episode but were in a phase of acute exacerbation (DFP). Materials and methods: The present study included 32 male FES, 28 male DFP, and 24 male healthy controls (HC). Groups were compared in terms of blood levels of adrenocorticotropic hormone (ACTH), cortisol, testosterone, progesterone, and DHEA-S. Results: Blood levels of ACTH, cortisol, testosterone, and progesterone were similar among the groups. The mean value of serum DHEA-S was significantly different among the groups (P<0.001). The value of serum DHEA-S was higher in the FES group than in the DFP and HC groups (both P<0.001). The mean values of serum DHEA-S in the HC and DFP groups were found to be similar (P=0.33). Conclusion: We suggest that higher values of DHEA-S in the FES group compared with both the DFP and HC groups indicate that this neurosteroid response is unique to first-episode schizophrenia patients. Further studies are needed to investigate the difference in blood levels of neurosteroids in different groups in terms of age of diagnosis

Misinterpretations of intrusions, obsessive beliefs and thought control strategies in patients with obsessive-compulsive disorder

Objective: Misinterpretations of intrusive experiences are suggested to play critical role in the development and maintenance of obsessive-compulsive disorder (OCD). Some faulty belief domains are also assumed to contribute to the immediate misappraisal of intrusions and thus, patients with OCD try to control their thoughts with various thought control strategies. This study aims to examine these cognitive concepts among Turkish patients with OCD and comparatively review the psychometric characteristics of three instruments in clinical samples. Methods: The sample of the study was constituted of patients with OCD and any other anxiety disorders and undergraduate university students as control group. An instrument set on immediate misinterpretations, beliefs, control strategies, responsibility attitudes, fusions of thoughts and actions, thought suppression, OCD symptoms, self-esteem and personality characteristics was administered to the sample. Results: Having acceptable reliability values, instrument tools of immediate interpretations, beliefs and thought control methods were found to be higher in OCD patients. These three factors were found to be significantly associated with other relevant cognitive correlates, while they were not related to some other factors such as psychoticism. Conclusion: These findings show that misinterpretations of intrusions, beliefs and control methods are also valid concepts in Turkish clinical samples that live in a different cultural context, and the self-report instruments of these cognitive factors were shown to display satisfactory psychometric properties

Reversible cycloplegia caused by duloxetine: a case report

A Duloxetine is a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine (SNRI) that has previously been shown to be effective in the treatment of major depressive disorder (MDD), generalized anxiety disorder, and diabetic peripheral neuropathic pain (DPNP). Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Here, we present a reversible cycloplegia case caused by duloxetine use. The patient was a 24 years-old woman with MDD diagnosis. Patient had somatic symptoms like fatigue, myalgia, and headache, besides her depressive symptoms for the last two months. Escitalopram and sertraline were used for her MDD before and she had to quit both owing to side effects such as nausea and drowsiness. Duloxetine 30mg/day treatment was started in our outpatient clinic. In her first follow-up exam, she reported light sensitivity and increased visual impairment. The visual impairment led dizziness and an increase in headache. She was consulted to ophthalmology unit of our hospital and cycloplegia was detected in her eye examination. Duloxetine was stopped in the ninth day of treatment but cycloplegia negatively affected the patient's daily life for almost 4 weeks and impaired her functionality. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects. Eye pain, changes in vision and swelling or redness in or around the eye are mentioned as possible visual side effects in the medication of duloxetine. The ocular and visual side effects from a patient's systemic medication can range from mild to severe. These side effects may or may not be serious enough to warrant discontinuing treatment. Cycloplegia seems as a rare adverse effect in antidepressant treatment and may take a long time to wash out. Recognition of ocular and visual side effects is important to prevent and minimize serious complications. In such visual disturbances, eye examination of the patient should be performed and the responsible drug should be discontinued as early as possible

The severity of dissociative symptoms among patients with cannabis and synthetic cannabinoid use disorder: association with substance use characteristics and suicide

Background: Chanarin Dorfman Syndrome (CDS) is a rare autosomal recessive disorder characterized by the multisytemic accumulation of neutral lipids inside the cytoplasmic lipid droplets. This condition is caused by mutations in the abhydrolase domain containing 5 gene (ABHD5). In CDS the skin involvement is the prevalent and always observed clinical feature, consisting of a non-bullous congenital ichthyosiform erythroderma (NCIE). Moreover, a variable involvement of the liver and neuromuscular system can be also observed. In this report, we aimed to perform the clinical and genetic characterization of a patient affected by CDS with atypical dermatological findings, considering this rare inborn error of neutral lipid metabolism. Methods: Genomic DNA samples obtained from patient and his parents were used to perform the sequencing of the ABHD5 exons and their intron/exon boundaries. Bioinformatic analyses were performed to investigate the possible effect of the identified mutation on protein structure. Results: Here we present the case of a 29-year-old male patient with CDS, who, for long time, has been misdiagnosed as pityriasis rubra pilaris (PRP). He has a history of increasing hyperlipidemia; hepatomegaly associated with hepatosteatosis was also detected. ABHD5 molecular analysis revealed a novel missense mutation, the c.811G > A (p.G271R). Bioinformatic investigations showed that the variant has a deleterious effect on ABHD5 function, probably causing an incorrect folding of the mutant protein. Conclusions: These results highlihts the importance of genetic testing for ABHD5 in unresolved cases of patients presenting unusual skin lesions, that resemble PRP, associated with a history of hyperlipidemia and nonalcoholic fatty liver

Pregabalin abuse among patients with opioid use disorders may increase the severity of withdrawal symptoms: a single-center, case-control study

OBJECTIVE: Opioid addiction is a disease that is increasing in our country, Turkey, and around the world, which it is difficult to treat in medical, social, and economic terms. Pregabalin is a preparation used for the treatment of epilepsy, neuropathic pain, and anxiety disorders. In opioid users, pregabalin is increasingly being self-administered off-label due to its euphoria effect at high doses. We investigated the effects of pregabalin on addiction profile and opioid withdrawal severity by comparing patients with opioid addiction who were and were not using off-label pregabalin. METHODS: Between July and August 2016, a total of 120 patients (60 patients were pregabalin users and 60 patients were non-users) who presented to Ankara Numune Training and Research Hospital Psychiatry Clinic Alcohol and Substance Addiction Treatment Center and were diagnosed with opioid use disorder according to the DSM-5, were included in the study. Patients who were using other substances were excluded from the study. A sociodemographic data form, the Clinical Opiate Withdrawal Scale, and Addiction Profile Index (API) were applied to the patients. RESULTS: There was no statistically significant difference between pregabalin users and pregabalin non-users in terms of age, sex, age of onset, working status, and whether previous treatment had been received. In the pregabalin user group, the severity of opioid withdrawal, API substance use characteristics, diagnosis, effects on life, craving, motivation subscale scores, and API total score were found to be significantly higher than in the non-user group. CONCLUSION: Off-label pregabalin use among patients with opioid addiction is becoming more common. Off-label, high-dose pregabalin use may worsen existing opioid addiction, create a new area of ??addiction, and an illegal market

Comparison of sociodemographic features, psychopathy and aggression levels of criminal and non-criminal schizophrenia patients

Objective: The aim of our study is to examine factors associated with involvement in crime in schizophrenia patients. Methods: One hundred and twenty consecutive patients diagnosed with schizophrenia according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) were included in the study. Based on their history of crime, the sample was divided into criminal (n=60) and non-criminal (n=60) groups. Sociodemographic Data Form, Positive and Negative Symptom Scale (PANSS), Psychopathy Checklist-revised (PCL-R) and Buss-Warren Aggression Questionnaire (BWAQ) were administered to each patient. Results: The criminal group was older than noncriminal group. It was observed that criminals tend to be more likely to be hospitalized. Smoking and self-harm were more common in criminal group. All PCL-R subscores were higher in criminals than non-criminals, however, PANSS and BWAQ scores were similar in both groups. In criminal group, substance abuse and self-harm were more common in patients involved in multiple crimes. Similarly, all PCL-R subscores and BWAQ-physical aggression subscore were higher in patients involved in multiple crimes. All BWAQ subscores have been shown to correlate positively with PANSS and PCL-R scores in criminal group. Conclusion: In schizophrenia patients, psychopathy, smoking, substance abuse, self-harm were associated with criminal behaviors. Therefore, these factors needs to be recognized as a formal and essential aspect of clinical management

Association of serum brain derived neurotropic factor with duration of drug-naive period and positive-negative symptom scores in drug naive schizophrenia

<div><p>Introduction</p><p>The aim of this study was to compare the serum brain derived neurotropic factor (BNDF) levels of patients with schizophrenia who had never received an antipsychotic treatment with those of a control group. Also, to analyze the relationship between the Positive and Negative Symptom Scale (PANSS) scores and BDNF levels of the patients during the period they were drug-naive.</p><p>Materials and methods</p><p>The sample of the study comprised patients who presentedto the Psychiatry Clinic and were admitted after a distinctive schizophrenia diagnosis was made in accordance with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnosis classification and who were not using and never had any antipsychotic medicine. A total of 160 participants were included in the study, 80 of whom had schizophrenia patients and 80 constituted the age- and sex-matched healthy control group. Before the start of the treatment, the serum samples to be checked for the BDNF levels were collected from the patients.</p><p>Results</p><p>The difference between the average BDNF levels of the groups were statistically significant (t = -5.25; p˂.001). An analysis as to whether there was a relation between the BDNF levels and the drug-naïve duration indicated no correlations. An examination of the relationship between PANSS scores and BDNF levels of the patients yielded no correlations.</p><p>Discussion</p><p>Serum BDNF levels seem to be one of the indicators of schizophrenia and its progress; nevertheless, we still do not have sufficient information about this neurotropic factor. In light of our study, the neurodevelopmental changes that occur at disease onset of the illness prominently affect the progress of the illness, which highlights the importance of the treatment in the early stages.</p></div

Thiol/Disulfide Homeostasis in Bipolar and Unipolar Depression

Objective: Bipolar disorder and unipolar depressive disorder are complex phenotypes. There appear to be phenotypical, mechanistic, and therapeutic differences between bipolar depression (BD) and unipolar depression (UD). There is a need for understanding the underlying biological variation between these clinical entities. The role of oxidative processes underlying bipolar disorder and depression has been demonstrated. Thiol-disulfide homeostasis (TDH) is a recent oxidative stress marker. In this study, we aimed to inspect patients with bipolar depression and unipolar depression in terms of thiol-disulfide balance and to compare them with healthy controls. Methods: Patients admitted to the outpatient clinic of Ankara Numune Training and Research Hospital and diagnosed either as a depressive episode with bipolar disorder (n = 37) or unipolar depression (n = 24) according to DSM-5 criteria, along with healthy controls (HC) (n = 50), were included in the study. Native thiol, total thiol, and disulfide levels were compared across the groups. Results: In comparison to HC, both BD and UD groups had higher disulfide levels, disulfide/native thiol ratio, and disulfide/total thiol ratio. No significant differences between BD and UD were detected in terms of disulfide level, disulfide/native thiol ratio, and disulfide/total thiol ratio. Conclusion: Increased levels of disulfide, native thiol, and disulfide/total thiol ratios compared to healthy controls in both UD and BD groups may be indicative of the presence of oxidative damage in these two clinical conditions. To clarify the role of oxidative stress in the pathophysiology of depressive disorders and investigate TDH, longitudinal studies in patients with medication-free UD and BD are required

Comparison of BDNF and PANSS scores between the different drug-naïve duration groups.

<p>Comparison of BDNF and PANSS scores between the different drug-naïve duration groups.</p