Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento

Background : Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective : The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods : In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion : Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse.Contexto : A eletroconvulsoterapia (ECT) tem mostrado ser um tratamento seguro e eficaz para esquizofrenia. No entanto, o número de estudos que avaliam a utilização contínua de ECT em pacientes com esquizofrenia e a resposta parcial ao tratamento farmacológico é limitado. Objetivo : O objetivo deste estudo é avaliar a eficácia da ECT de continuação na prevenção de recaída em pacientes com esquizofrenia resistente ao tratamento. Métodos : Nesta análise retrospectiva, pacientes com esquizofrenia (n = 73) foram alocados em três grupos: pacientes que receberam apenas o tratamento AP (somente AP), pacientes que receberam um curso agudo de ECT durante a hospitalização (aECT+AP) e pacientes que receberam um curso agudo de ECT durante a hospitalização e ECT de continuação (a-cECT+AP). Esses três grupos foram comparados de acordo com a pontuação atribuída na Positive and Negative Syndrome Scale (PANSS) e na Brief Psychiatric Rating Scale (BPRS). Resultados : De acordo com a comparação dos grupos, somente em AP, aECT+AP e a+cECT+AP, em termos de PANSS e BPRS, após descarga no primeiro, terceiro e sexto mês, as pontuações na PANSS no terceiro e sexto mês no grupo a+cECT+AP foram estatística e significativamente menores do que nos outros dois grupos. Conclusões : Embora este estudo mostre limitações causadas pela análise retrospectiva de prontuários, os resultados sugerem que a continuação da ECT em combinação com antipsicóticos é mais eficaz do que somente os antipsicóticos, na prevenção da recaída em pacientes com diagnóstico de esquizofrenia que responderam ao curso agudo de ECT

Dissociative experiences in bipolar disorder II: Are they related to childhood trauma and obsessive-compulsive symptoms?

Objective The aim of this study is to investigate the presence of dissociative symptoms and whether they are related to childhood trauma and obsessive-compulsive symptoms in bipolar disorder type II (BD-II). Methods Thirty-three euthymic patients (HDRS<8, YMRS<5) and 50 healthy subjects were evaluated by SCID-I and SCID-NP. We excluded all first and second-axis comorbidities. All patients and healthy subjects were examined with the Dissociative Experiences Scale (DES), Childhood Trauma Questionnaire (CTQ-53), and Yale-Brown Obsessive-Compulsive Disorder scale (Y-BOCS). Results In pairwise comparisons between the BD-II and control groups, the total CTQ, emotional abuse, emotional neglect, DES, and total Y-BOCS scores in the BD-II group were significantly higher than those in the control group (p < 0.05). There were five cases with DES scores over 30 (15.2%) and one case (2%) in the control group. DES was weakly correlated with total CTQ and Y-BOCS in patients diagnosed with BD-II (r = 0.278, p < 0.05 and r = 0.217, p < 0.05, respectively). While there was no correlation between total CTQ and Y-BOCS, the CTQ sexual abuse subscale was found to be related to Y-BOCS (r = 0.330, p < 0.05). Discussion These results suggest that there is a relation between childhood traumas and obsessive-compulsive symptoms, or that dissociative symptoms are more associated with anxiety than obsessive symptoms, which prevents the increase of obsessive-compulsive symptoms in BD-II

Dissociative experiences in bipolar disorder II: Are they related to childhood trauma and obsessive-compulsive symptoms?

Objective The aim of this study is to investigate the presence of dissociative symptoms and whether they are related to childhood trauma and obsessive-compulsive symptoms in bipolar disorder type II (BD-II). Methods Thirty-three euthymic patients (HDR

The first horse herders and the impact of early Bronze Age steppe expansions into Asia.

The Yamnaya expansions from the western steppe into Europe and Asia during the Early Bronze Age (~3000 BCE) are believed to have brought with them Indo-European languages and possibly horse husbandry. We analyzed 74 ancient whole-genome sequences from across Inner Asia and Anatolia and show that the Botai people associated with the earliest horse husbandry derived from a hunter-gatherer population deeply diverged from the Yamnaya. Our results also suggest distinct migrations bringing West Eurasian ancestry into South Asia before and after, but not at the time of, Yamnaya culture. We find no evidence of steppe ancestry in Bronze Age Anatolia from when Indo-European languages are attested there. Thus, in contrast to Europe, Early Bronze Age Yamnaya-related migrations had limited direct genetic impact in Asia

Serum resolvin D1 levels as a marker of inflammation in constipation dominant irritable bowel syndrome

WOS: 000518828400005PubMed: 32141819Background/Aims: The objective of this study is to determine the role of circulating resolvin D1 (RvD1) in patients with constipation subtype of irritable bowel syndrome (IBS-C) and evaluate the relationship between abdominal pain severity and RvD1 levels. Materials and Methods: This research included 55 patients with IBS-C and 36 healthy controls. Controls were selected from patients who applied to our department with similar complaints as IBS but were not diagnosed with any type of pathology after further investigations. All participants underwent complete blood count, C-reactive protein (CRP), and RvD1 levels measurements. We also recorded abdominal pain severity and the number of bowel movements. Patients with IBS-C were compared with respect to the demographic features and laboratory measurements. Results: The median CRP concentration in patients with IBS-C was significantly higher than that of controls (p=0.003). However, the median RvD1 concentration was significantly lower in the IBS group than that of the control group (p<0.001). The receiver operating characteristic curve analyses revealed that RvD1 concentration lower than 0.47 ng/mL and CRP concentration higher than 3.40 mg/L may identify patients with IBS-C with a high specificity. In the IBS group, there was a strong negative correlation between abdominal pain severity and RvD1 concentration (r=-0.766, p=0.001). Conclusion: This research demonstrates that patients with IBS-C have higher CRP and lower RvD1 concentrations than healthy controls. Both RvD1 and CRP concentrations predict the presence of IBS-C. Additionally, RvD1 concentrations decreased with the increase in abdominal pain severity. Further research works are needed for investigating the role of the RvD1 analogs in the treatment of IBS

Immediate unprepared polyethylene glycol-flush colonoscopy in elderly patients with severe lower gastrointestinal bleeding

Gul Utku, Ozlem/0000-0003-1043-2627WOS:000539973200006PubMed: 32207216Aims Colon preparation is vital yet more difficult in elderly patients with severe lower gastrointestinal bleeding (LGIB). The aim of this study is to show the efficacy, safety and outcomes of unprepared polyethylene glycol (PEG)-flush retrograde colon cleansing in the diagnosis and treatment of elderly home care patients with LGIB. Methods A single-center study was performed between January 2014 and June 2018. Elderly home healthcare patients presenting with hematochezia were enrolled, and an unprepared retrograde bowel cleansing colonoscopy was performed within the first 8 h after admission to the emergency department. PEG solution (2 L) was added to the water jet tank, and jet pump injection was started from the left side of the colon to the right segment of the colon and ended up at the cecum. Results In total, 33 elderly patients presenting with hematochezia were evaluated. Mean inward and outward procedure times were 17.06 +/- 4.92 (8-33 min) and 28.66 +/- 6.88 (10-30 min), respectively. Most of the bleeding was localized in the right colon at 22 patients (66.3%). Endoscopic treatment was performed in 87.9% of patients. The average length of stay in hospital was 44.70 +/- 42.81 (range 18.00-240.00 h). Conclusions Immediate unprepared PEG-flush colonoscopy in elderly home care patients with acute LGIB is a safe and effective method, which detects bleeding sources and provides endoscopic therapy. With this procedure, the time of hospital stay is reduced. This approach may be used for the initial intervention in patients admitted to emergency departments or intensive care unit with severe acute LGIB.Geriatr Gerontol Int 2020; center dot center dot: center dot center dot-center dot center dot

Kesmek veya kesmemek: Valproatın elektrokonvülzif tedavi ile birlikte kullanımı

Amaç: Valproat ve elektrokonvülsif tedavinin bir arada kullanımı tartışmalı bir konudur. Duygudurum düzenleyici olarak kullanılan antikonvulzanların EKT sırasında nöbetin ortaya çıkışını olumsuz etkilemesinden endişe edilir. Bu araştırmada bipolar bozukluk manik epizot hastalarında elektrokonvülzif tedavi ile eşzamanlı kullanılan tam doz ya da azaltılmış dozdaki valproatın klinik etkileri incelenmiştir. Yöntem: Nisan 2010-Temmuz 2013 ayları arasında bir psikiyari hastanesinde bipolar bozukluk manik epizot tanısı ile elektrokonvülzif tedavi alan, epileptik olmayan, araştırma kriterlerine uygun ardışık 75 hastanın kayıtları incelenmiştir. Nöbet için gerekli enerji düzeyi, nöbet süresi, uygulanan elektrokonvülsif tedavi seans sayısı ve young Mani Ölçeği skorlarındaki değişim, EKT esnasında tam dozda valproat kullanan, % 40 azaltılmış dozda valproat kullanan ve valproat ya da başka bir antikonvülzan kullanmayan hasta grupları arasında karşılaştırılmıştır. Bulgular: Her üç grup karşılaştırıldığında geçirilen nöbet süreleri açısından kontrol grubu ile valproat doz ayarlaması yapılan grup arasında nöbet süreleri açısından fark saptanmamışken (p=0.078), kontrol grubu ile valproat doz ayarlaması yapılmayan grup arasında nöbet süreleri açısından fark saptanmıştır (p=0.038). Remisyona ulaşmak için gerek duyulan EKT seans sayısı tam doz valproat kullanan grupta anlamlı biçimde daha yüksek bulunmuştur. Valproat ile EKT’nin eşzamanlı kullanımı iyi tolere edilmiş, tam doz ya da azaltılmış doz valproat kullanan hastalarda ciddi bir yan etki izlenmemiştir. Tüm olgularda Young Mani skorunda anlamlı düşme ve klinik remisyon izlenmiştir. Tartışma: Valproatın EKT ile eşzamanlı kullanımı rutin EKT uygulamasına engel oluşturmamış ve koruyucu duygudurum düzenleyici tedavisine geçişi hızlandırmıştır. Bu bulguların doğrulanması ve kognitif yan etkilerin gruplar arasında kıyaslanabilmesi için ileriye dönük araştırmalara ihtiyaç bulunmaktadır

Decreased mean platelet volume in panic disorder

AIM: The relationship between psychological stress and platelet activation has been widely studied. It is well known that platelets may reflect certain biochemical changes that occur in the brain when different mental conditions occur. Platelet 5-hydroxytryptamine (5-HT) is also extensively studied in psychiatry. The mean platelet volume (MPV), the accurate measure of platelet size, has been considered a marker and determinant of platelet function. The aim of the present study was to search for any probable difference in the MPV of subjects with panic disorder (PD). METHODS: A total of 37 drug-free subjects, aged 18 to 65 years, diagnosed with PD, with or without agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria and 45 healthy control subjects were included in the study. Platelet count and MPV were measured and recorded for each subject. RESULTS: There were no statistically significant differences between groups in terms of female/male ratio, age, or body mass index between the PD group and control group (P=0.91, P=0.82, and P=0.93, respectively). The MPV was found to be significantly lower in the PD group compared with the control group (8.8±0.9 fL vs 9.2±0.8 fL; P=0.02). All the participants had MPV values in the standard range of 6.9-10.8 fL. CONCLUSION: We concluded that abnormalities of the 5-HT1A receptor function in the central nervous system of subjects with a diagnosis of PD are also mirrored in as an alteration in platelet activity. Measurements of platelet activity may be used as a tool for neuropsychiatric and psychopharmacological research and for studying how certain mental diseases and medications affect the central nervous system

The Performance of Nesfatin-1 in Distinguishing Irritable Bowel Syndrome Presenting Predominantly with Diarrhea from Celiac Disease

WOS:000545455100028PubMed: 32162872Background: We hypothesized that nesfatin-1, an anti-inflammatory peptide, could be used as a non-invasive diagnostic tool in the identification of celiac disease (CD) and irritable bowel syndrome presenting predominantly with diarrhea (IBS-D). Methods: Thirty-five patients with IBS-D who met the Rome III criteria, 28 patients with celiac disease who met the diagnostic criteria of the Marsh-Oberhuber classification, and 30 age- and gender-matched healthy controls were included in this cross-sectional study. All subjects responded to the IBS Severity Scoring System (IBS-SSS) questionnaire that was used to determine pain severity, pain frequency, bloating, dissatisfaction with bowel habits, and life interference. Results: Nesfatin-1 levels were significantly higher in the CD group compared to the IBS-D group and healthy controls. Nesfatin-1 was also higher in the IBS-D group compared to controls. Nesfatin-1 levels were correlated with IBS-SSS (r = 0.884, p 98.1 pg/mL for nesfatin-1 could discriminate subjects with CD from those with IBS-D and also healthy controls with a sensitivity of 82% and a specificity of 80%. Conclusions: The results of this study show that subjects with CD have higher nesfatin-1 levels compared to those with IBS-D or to the healthy controls. Moreover, nesfatin-1 can discriminate subjects with CD from those with IBS-D and also healthy controls, with high sensitivity and specificity. Further studies with histopathological evaluation are required to clearly address the role of nesfatin-1 in the diagnosis of CD

Transcranial Direct Current Stimulation in a Patient With Schizoaffective Disorder Manic Episode.

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique in which a weak current is applied through the scalp to produce changes in neuronal excitability in the underlying cerebral tissue (1). tDCS attracted the attention of clini-cians and scientists due to its powerful effect on cortical function. This technique is based on the application of weak direct electrical currents (1–2 mA) to the scalp via surface electrodes. This results in an increase or decrease of the excitability of the cortical area under-lying the electrodes. tDCS has shown to exert its effects by modu-lating membrane neuronal threshold and spontaneous neuronal activity, therefore leading to hyperpolarization or depolarization according to the polarity of stimulation (2,3). Recent clinical trials have shown promising results with left anodal prefrontal tDCS in treating depression (4). In their recent research, Brunoni et al. reported that in major depressive disorder, the combination of tDCS and sertraline increases the efficacy of each treatment. The efficacy and safety of tDCS and sertraline did not differ (5). Shiozawa et al. reported tDCS modulation of visual hallucinations in schizophrenia and a case report of using tDCS for catotonia (6,7). In a recent report, Schestatsky et al. reported that with five sessions of anodal tDCS over the right dorsolateral prefrontal cortex, there were some improvements in both agitation and manic symptoms in a patient with an episode of mania with sexual hyperactivity (8). This report investigates the answer for the question of whether tDCS can be a treatment option in manic episodes. PATIENT AND METHOD The case is a 68-year-old female Caucasian patient suffering from schizoaffective disorder manic episode, diagnosed by the struc-tured clinical interview for Diagnostic and Statistical Manual of Mental Disorders IV. She was diagnosed with schizoaffective disor-der at the age of 28. The affective episodes were predominantly manic, with episodes occurring one to two times a year. She described persecutional delusions and auditory hallucinations between the affective episodes. She was on antipsychotic medica-tion continuously for 28 years. On her manic episodes, she was experiencing days to weeks of elevated and expansive mood, increased activity, decreased need for sleep, and increased talk-ativeness and socializing. Her auditory hallucinations also increased in manic episodes. She had used almost every known mood stabi-lizers and antipsychotic with poor clinical response. From the age of 28, she needed hospitalization on nine occasions owing to worsen-ing manic symptoms. Three, six, and 12 years ago, the patient par-ticipated in three clinical trials of electroconvulsive treatment for the treatment of manic episodes. One year ago, ten sessions of repeti-tive transcranial magnetic stimulation (rTMS) was administered at 1 Hz (inhibitory frequency) at 120% motor threshold, 1500 pulses on each session over the right prefrontal cortex. Clinical response was partial to electroconvulsive treatment and poor to rTMS. A therapeutic regimen of lithium 900 mg/d (blood concentration, 0.78 mmol/L) and risperidone 4 mg/d was given with a diagnosis of schizoaffective disorder manic episode. She did not respond to treatment. Despite further reasonable mood stabilizer trials (lamotrigine, valproate, olanzapine), her clinical response was incomplete and not sustained. The patient participated in a clinical trial of tDCS for the treatment of manic episode after being assessed by her own treating psychia-trist as being capable of giving informed consent. She gave written informed consent for both trials and the publication of this case report. She underwent cathodal stimulation of the right dorsolateral pre-frontal cortex and anodal stimulation of contralateral deltoid muscle more than three weeks as an add-on treatment to a stable antipsychotic and mood stabilizer medication. Direct current was transferred by a saline-soaked pair of surface sponge electrodes (35 cm 2) and delivered by tDCS equipment (Medelec Ltd, Surrey, UK). The cathodal electrode was over F4. Patient received 2 mA tDCS for 15 min each day with a total of 20 sessions. The patient was assessed at baseline, after ten and 20 sessions of tDCS, and one month after the end of treatment. There was a significant improve-ment in manic symptoms and mania scores after treatment. Her clinical scale scores are given in Table 1. Her clinical outcome was satisfactory, and her mood returned to euthymia within a month. One month after ceasing tDCS, her moo