Tardive Blepharospasm and Meige Syndrome during Treatment with Quetiapine and Olanzapine

Meige syndrome, which has been presented in tardive syndromes, is a form of blepharospasm accompanied by oromandibular dystonia with manifestations over the face, jaw, and neck. A blepharospasm can be induced by antihistamines, dopaminomimetic or sympathomimetic drugs, or long-term exposure to dopamine antagonists. Atypical antipsychotics have less extrapyramidal side effects because of a weak dopamine D2 receptor binding affinity or a strong antagonistic effect to serotonin 5-HT2a receptor and have been known to cause less tardive dyskinesia than typical antipsychotics. Thus, in literature, atypical antipsychotics are recommended for the treatment of psychosis in cases of tardive dyskinesia. The potential risk factors associated with the development of tardive dyskinesia are extrapyramidal symptoms' history, diabetes mellitus, affective disorder, female gender, older age, and long-term therapy with neuroleptics at higher dosages. As reported below, a patient with an affective disorder who had quetiapine-induced oromandibular dystonia and olanzapine-induced Meige syndrome after antipsychotic augmentation in different stages of the disease process was presented

Sociotropic personality traits positively correlate with the severity of social anxiety

Aim. To investigate sociotropic-autonomic personality characteristics and their clinical implications in social anxiety disorder (SAD).  Methods. The study included 68 consecutive patients who were either being followed up on an outpatient basis or presented for the first time to the psychiatric clinics of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery or Trakya University School of Medicine between May 2012 and May 2013, and were diagnosed primarily with generalised SAD according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria. Beck Depression Inventory (BDI), Sociotropy-Autonomy Scale (SAS), Symptom Checklist-90-R (SCL-90-R), Liebowitz Social Anxiety Scale (LSAS) and a sociodemographic data collection form designed by the authors were used as primary assessment instruments.  Results. The mean age (standard deviation (SD)) of the sample group was 23.73 (8.85) years; 37 (54.4%) were female and 31 (45.6%) were male. LSAS mean (SD) total fear score was 63.51 (13.74), mean total avoidance score was 61.24 (14.26), BDI mean score was 16.99 (9.58), SAS mean sociotropy score was 71.06 (16.79), and mean autonomy score was 63.22 (16.04). A statistically significant positive correlation was found between SAS sociotropy scores and LSAS fear and avoidance total scores, BDI scores and all subscales of SCL-90-R (p<0.01). There were no statistically significant correlations between SAS autonomy scores and LSAS fear and avoidance total scores, BDI scores and all subscales of SCL-90-R (p>0.05).  Conclusion. Sociotropic personality characteristics in patients with SAD have been found to positively correlate with depression and social anxiety levels. Addressing this finding during treatment sessions and helping the patient increase flexibility in appraisal of social life events may have a positive impact on treatment outcome

Executive functions and thyroid volumes in bipolar patients on lithium treatment

Aim: The purpose of this study was to investigate the relationship between executive functions and thyroid ultrasound parameters in remitted bipolar patients who were on lithium treatment. Methods: In the current study, 25 remitted patients with diagnoses of Bipolar I Disorder having blood lithium, and thyroid hormone levels within the normal range were consecutively enrolled. Healthy control group consisted of 25 euthyroid people matched as an age, sex and education level with the patients. Semi-structured sociodemographic and clinical form, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Montreal Cognitive Assessment (MoCA), the Hamilton Depression Scale, Young Mania Rating Scale, thyroid ultrasonography and the Wisconsin Card Sorting Test (WCST) were applied to both groups. Within the patient group, correlation analysis was performed between WCST performance and thyroid volume. Results: In the present study, no significant difference was found between the bipolar and the healthy control groups regarding the executive functions as measured via WCST. In the bipolar patients, there were no statistically significant correlations among WCST scores and thyroid volumes. Conclusion: Thyroid volumes are not appeared to be associated with executive functions in euthymic bipolar patients.Publisher's Versio

Cognitive Behavioral Therapy in Social Anxiety Disorder: Current Concepts

Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(3.000): 229-243

Comparison of sociodemographic and clinical characteristics of unipolar and bipolar geriatric inpatients

Amaç: Bipolar bozukluk, toplumda %1 oranında görülen kronik bir hastalık olmakla beraber, yaşlılardaki yaygınlık oranı % 0.1 kadar düşüktür. Major depresyonun ise 70-85 yaşından sonra prevalans ve insidansı iki kat artmaktadır. Çalışmanın amacı, yatarak tedavi gören bipolar bozukluk(BB) ve unipolar depresyon(UD) tanılarıyla izlenen geriyatrik hastaların sosyodemografik ve klinik özelliklerinin araştırılmasıdır.Yöntem: Çalışmada Bakırköy Ruh ve Sinir Hastalıkları Hastanesi’nde yatmış olan, 65 yaş ve üzeri BB ve UD hastalarının sosyodemografik ve klinik özellikleri tıbbi kayıtları üzerinden karşılaştırılmıştır. Madde/ilaç, başka bir sağlık durumuna bağlı duygudurum bozukluğu tanısı olanlar ya da demans, deliryum tanısı olan hastalar çalışmaya dahil edilmemiştir. Bulgular: Tüm hastaların yaş ortalaması 69,3’tür. Çalışmaya dahil edilen 93 hastanın 51 tanesinde (%54,8) BB, 42 tanesinde(%45,2) UD tanısı bulunmaktadır. Hastalığın başlangıç yaşı BB için 41,33 iken UD için 59,21 bulunmuştur(p=0,000). UD hasta grubunun yatışındaki intihar fikri oranı %78,6 olup BB hasta grubununki %17,6’dır(p=0,000). UD grubundan 20(%47.6) kişi daha önce en az bir kere intihar girişiminde bulunmuşken bu sayı bipolar hasta grubunda 12(%23.5) olarak saptanmıştır(p=0,03). BB hastalarının ilaç uyumsuzluğu %51,0 iken UD hastalarında (%26,2) anlamlı derecede düşüktür (p=0,000). BB grubunun tedavisinde antipsikotikler (%100), depresyon hastalarına (%76,2) oranla daha sık kullanılmıştır(p=0,000). Sonuçlar: Yatarak tedavi görmüş unipolar ve bipolar geriyatrik hastalarda önemli klinik farklar saptanmıştır.Objective: Bipolar disorder (BD) is a chronic disease of 1% in the population although the prevalence in the elderly is low as 0.1%. The prevalence and incidence of major depression doubled after the age of 70-85. The aim of this study was to investigate sociodemographic and clinical characteristics of geriatric inpatients with bipolar disorder and unipolar depression (UD). Methods: In the study, demographic and clinical characteristics of 65 years and older patients with BD and UD who hospitalized in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were compared through medical records. Patients diagnosed with substance/medication-induced mood disorders, mood disorders due to another medical condition or dementia, delirium were excluded from the study. Results: The average age of patients is 69.3 years. The study included 93 patients; 51 patients (54.8%) are diagnosed BD, 42 of them (45.2%) are diagnosed UD. The age of onset was found 59.21 years for UD and 41.33 years for BD (p=0.000). Hospitalization ratio in the patients with suicidal ideation was 78.6% (n=33) in UD and 17.6% (n=9) in BD (p=0.000). While 20 of UD patients (47.6%) had suicide attempt at least once, 12 of BD patients (23.5%) attempted suicide before (p=0.03). The drug inadherence ratio in BB patients was found 51.0% (n=26), while it was significantly lower in UD patients (26.2%; n=11) (p=0.000). Antipsychotics were used in the treatment with 100% in BB group (n= 51) and 76.2% (n=32) in UD group (p=0.000). Conclusions: Important clinical differences were detected between geriatric unipolar and bipolar inpatients.Publisher's Versio