Fluphenazine decanoate (depot) and enanthate for schizophrenia

Background: Intramuscular injections (depot preparations) offer an advantage over oral medication for treating schizophrenia by reducing poor compliance. The benefits gained by long-acting preparations, however, may be offset by a higher incidence of adverse effects. Objectives: To assess the effects of fluphenazine decanoate and enanthate versus oral anti-psychotics and other depot neuroleptic preparations for individuals with schizophrenia in terms of clinical, social and economic outcomes. Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (February 2011 and October 16, 2013), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Selection criteria: We considered all relevant randomised controlled trials (RCTs) focusing on people with schizophrenia comparing fluphenazine decanoate or enanthate with placebo or oral anti-psychotics or other depot preparations. Data collection and analysis: We reliably selected, assessed the quality, and extracted data of the included studies. For dichotomous data, we estimated risk ratio (RR) with 95% confidence intervals (CI). Analysis was by intention-to-treat. We used the mean difference (MD) for normal continuous data. We excluded continuous data if loss to follow-up was greater than 50%. Tests of heterogeneity and for publication bias were undertaken. We used a fixed-effect model for all analyses unless there was high heterogeneity. For this update. we assessed risk of bias of included studies and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to create a 'Summary of findings' table. Main results: This review now includes 73 randomised studies, with 4870 participants. Overall, the quality of the evidence is low to very low.Compared with placebo, use of fluphenazine decanoate does not result in any significant differences in death, nor does it reduce relapse over six months to one year, but one longer-term study found that relapse was significantly reduced in the fluphenazine arm (n = 54, 1 RCT, RR 0.35, CI 0.19 to 0.64, very low quality evidence). A very similar number of people left the medium-term studies (six months to one year) early in the fluphenazine decanoate (24%) and placebo (19%) groups, however, a two-year study significantly favoured fluphenazine decanoate (n = 54, 1 RCT, RR 0.47, CI 0.23 to 0.96, very low quality evidence). No significant differences were found in mental state measured on the Brief Psychiatric Rating Scale (BPRS) or in extrapyramidal adverse effects, although these outcomes were only reported in one small study each. No study comparing fluphenazine decanoate with placebo reported clinically significant changes in global state or hospital admissions.Fluphenazine decanoate does not reduce relapse more than oral neuroleptics in the medium term (n = 419, 6 RCTs, RR 1.46 CI 0.75 to 2.83, very low quality evidence). A small study found no difference in clinically significant changes in global state. No difference in the number of participants leaving the study early was found between fluphenazine decanoate (17%) and oral neuroleptics (18%), and no significant differences were found in mental state measured on the BPRS. Extrapyramidal adverse effects were significantly less for people receiving fluphenazine decanoate compared with oral neuroleptics (n = 259, 3 RCTs, RR 0.47 CI 0.24 to 0.91, very low quality evidence). No study comparing fluphenazine decanoate with oral neuroleptics reported death or hospital admissions.No significant difference in relapse rates in the medium term between fluphenazine decanoate and fluphenazine enanthate was found (n = 49, 1 RCT, RR 2.43, CI 0.71 to 8.32, very low quality evidence), immediate- and short-term studies were also equivocal. One small study reported the number of participants leaving the study early (29% versus 12%) and mental state measured on the BPRS and found no significant difference for either outcome. No significant difference was found in extrapyramidal adverse effects between fluphenazine decanoate and fluphenazine enanthate. No study comparing fluphenazine decanoate with fluphenazine enanthate reported death, clinically significant changes in global state or hospital admissions. Authors' conclusions: There are more data for fluphenazine decanoate than for the enanthate ester. Both are effective antipsychotic preparations. Fluphenazine decanoate produced fewer movement disorder effects than other oral antipsychotics but data were of low quality, and overall, adverse effect data were equivocal. In the context of trials, there is little advantage of these depots over oral medications in terms of compliance but this is unlikely to be applicable to everyday clinical practice.Full Tex

Ud eğitimi ile ilgili üç yaklaşımın (Cinuçen Tanrıkorur, Mutlu Torun, Gülçin Yahya Kaçar) mukayesesi ve bir model önerisi

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Ud eğitiminde mevcut yaklaşımlardan günümüzde en sık kullanılan metodlar incelenmiş olup, ortak özellikleri ve birbirinden ayrılan özellikleri tespit edilerek farklı bir yaklaşım öneri olarak sunulmuştur.Lute current approaches to the education of today's most frequently used methods are examined, which are separated by the common features and characteristics will be identified and a different approach is presented as a proposal

Preoperative Evaluation in Obstructive Sleep Apnea Syndrome

In patients with Obstructive sleep apnea syndrome (OSAS), preoperative evaluation should be routinely done in all patients with OSAS undergoing surgery or in all patients suspected to have OSAS to avoid problems during perioperative (pre-intra-post) stages. The detection of OSAS severity, the prediction of perioperative anesthesia risk, preoperative medication and difficult entubation should be taken in account. Preventive measures should be taken

Türk müziği devlet konservatuarlarında okutulan ses eğitimi dersine yönelik bir öğretim modeli önerisi

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Ülkemizde müzik eğitimine yönelik çok sayıda kurum vardır. Bu kurumlar içerisinde mesleki müzik eğitimi alanında eğitim veren konservatuvarlar, kuruluş amacı bakımından akademik eğitim vermede önemli yer tutmaktadır. Bu kurumlar kuruluş amaçları ve üstlendikleri rol bakımından dünya standartlarında eğitim vermek ve Türk müzik kültürüne önemli katkılarda bulunabilmek için çağdaş bir eğitim anlayışı ve çağdaş eğitim yöntemleriyle varlığını sürdürmelidir.Yapılan araştırmada Türk Müziği Devlet Konservatuvarlarındaki ses eğitimi bölümlerinin, ses eğitimi derslerinde uygulanan yöntemlerine değinilerek, sesin güzel ve etkili kullanılabilmesi için gerekli olan çalışmalara yer verilmiş ve öğrenilen bu bilgilerin doğru kullanılmasıyla beraber dersin uygulanma aşamasında farklı icra teknikleri kullanılarak yapılan bu çalışma sonrasında, ses eğitiminde Türk müziği üslûp ve tavrını geliştirme konusuna katkı sağlayacağı düşünülen bazı öneriler getirilmiştir.Bu araştırmada; Türk Müziği Devlet Konservatuvarlarında okutulan Ses Eğitimi derslerinde, öğrencilerin Ses Eğitimi dersinin ilke ve amaçları ile beraber Form Bilgisi, Usûl dersleri ve Repertuar derslerinde öğrendikleri bilgilerini, aldıkları ses eğitimi ile bağdaştırarak daha etkili bir Türk müziği üslûbu ve tavrı kazandırılmaya çalışılmıştır. Hazırlanan model önerisinde öğrencinin seviyesi göz önünde tutularak, eser örneğine yer verilmiş ve Türk Müziği formlarından biri olan ?şarkı? formuna ait bir eserle öğretim modeli önerisi oluşturulmaya çalışılmıştır. Türk Müziği Devlet Konservatuvarlarındaki Ses Eğitimi derslerinin Türk Müziği üslûp ve tavrına olan katkılarını değerlendirmenin büyük faydalar sağlayacağı düşüncesinden yola çıkılarak yapılan araştırma, Türk Sanat Müziği ses eğitiminin niteliğini ortaya çıkarmaya çalışan yapısıyla önem taşımaktadır. Bu alana yönelik yapılmış çalışmaların nicelik açısından az olması araştırmanın önemini daha da arttırmakta, kendisinden sonra yapılacak çalışmalara da ışık tutması amaçlanmaktadır.Ülkemizde müzik eğitimine yönelik çok sayıda kurum vardır. Bu kurumlar içerisinde mesleki müzik eğitimi alanında eğitim veren konservatuvarlar, kuruluş amacı bakımından akademik eğitim vermede önemli yer tutmaktadır. Bu kurumlar kuruluş amaçları ve üstlendikleri rol bakımından dünya standartlarında eğitim vermek ve Türk müzik kültürüne önemli katkılarda bulunabilmek için çağdaş bir eğitim anlayışı ve çağdaş eğitim yöntemleriyle varlığını sürdürmelidir.Yapılan araştırmada Türk Müziği Devlet Konservatuvarlarındaki ses eğitimi bölümlerinin, ses eğitimi derslerinde uygulanan yöntemlerine değinilerek, sesin güzel ve etkili kullanılabilmesi için gerekli olan çalışmalara yer verilmiş ve öğrenilen bu bilgilerin doğru kullanılmasıyla beraber dersin uygulanma aşamasında farklı icra teknikleri kullanılarak yapılan bu çalışma sonrasında, ses eğitiminde Türk müziği üslûp ve tavrını geliştirme konusuna katkı sağlayacağı düşünülen bazı öneriler getirilmiştir.Bu araştırmada; Türk Müziği Devlet Konservatuvarlarında okutulan Ses Eğitimi derslerinde, öğrencilerin Ses Eğitimi dersinin ilke ve amaçları ile beraber Form Bilgisi, Usûl dersleri ve Repertuar derslerinde öğrendikleri bilgilerini, aldıkları ses eğitimi ile bağdaştırarak daha etkili bir Türk müziği üslûbu ve tavrı kazandırılmaya çalışılmıştır. Hazırlanan model önerisinde öğrencinin seviyesi göz önünde tutularak, eser örneğine yer verilmiş ve Türk Müziği formlarından biri olan ?şarkı? formuna ait bir eserle öğretim modeli önerisi oluşturulmaya çalışılmıştır. Türk Müziği Devlet Konservatuvarlarındaki Ses Eğitimi derslerinin Türk Müziği üslûp ve tavrına olan katkılarını değerlendirmenin büyük faydalar sağlayacağı düşüncesinden yola çıkılarak yapılan araştırma, Türk Sanat Müziği ses eğitiminin niteliğini ortaya çıkarmaya çalışan yapısıyla önem taşımaktadır. Bu alana yönelik yapılmış çalışmaların nicelik açısından az olması araştırmanın önemini daha da arttırmakta, kendisinden sonra yapılacak çalışmalara da ışık tutması amaçlanmaktadır.There are a lot of institutions for music education in our country. Among these institutions conservatoires take an important place in academic education in terms of founding purpose. These institutions should survive with contemporary education concept and education methods in order to educate in world standards when their founding purpose and the role they undertake are taken into consideration.In the study methods used in voice education in State Conservatories of Turkish Music are mentioned discussing the necessary works in order to use voice effectively and beautifully and following this work using different ensemble techniques in the application process of the lesson, some suggestions are developed which we believe they will make contribution to the improvement of voice education in the style and manner of Turkish music.Also this study tries to entitle a more effective Turkish music style and manner by relating students? knowledge of voice training learnt through Form Information, Style lessons and Repertoire lessons together with the aims and purposes of Voice training lesson studied at State Turkish Music Conservatories. In the prepared Suggested Model an example of musical work is given according to the class level of students, and an education model suggestion is developed by using a ?song? which is one of the forms of Classical Turkish Music.This study, accepting Voice Training lessons in State Conservatories of Turkish Music as a main contributor to the style and manner of Classical Turkish Music, has an importance with its aspect of revealing the nature of Classical Turkish Music Voice Training. Since the number of studies on this field is small the importance of this study becomes more evident. The study also aims to light the way for further studies

Do we have any solid evidence of clinical utility about the pathophysiology of schizophrenia?

A diagnosis of schizophrenia, as in most of psychiatric practice, is made largely by eliciting symptoms with reference to subjective, albeit operationalized, criteria. This diagnosis then provides some rationale for management. Objective diagnostic and therapeutic tests are much more desirable, provided they are reliably measured and interpreted. Definite advances have been made in our understanding of schizophrenia in recent decades, but there has been little consideration of how this information could be used in clinical practice. We review here the potential utility of the strongest and best replicated risk factors for and manifestations of schizophrenia within clinical, epidemiological, cognitive, blood biomarker and neuroimaging domains. We place particular emphasis on the sensitivity, specificity and predictive power of pathophysiological indices for making a diagnosis, establishing an early diagnosis or predicting treatment response in schizophrenia. We conclude that a number of measures currently available have the potential to increase the rigour of clinical assessments in schizophrenia. We propose that the time has come to more fully evaluate these and other well replicated abnormalities as objective potential diagnostic and prognostic guides, and to steer future clinical, therapeutic and nosological research in this direction

Effects of cranial electrotherapy stimulation on resting state brain activity

Cranial electrotherapy stimulation (CES) is a U.S. Food and Drug Administration (FDA)-approved treatment for insomnia, depression, and anxiety consisting of pulsed, low-intensity current applied to the earlobes or scalp. Despite empirical evidence of clinical efficacy, its mechanism of action is largely unknown. The goal was to characterize the acute effects of CES on resting state brain activity. Our primary hypothesis was that CES would result in deactivation in cortical and subcortical regions. Eleven healthy controls were administered CES applied to the earlobes at subsensory thresholds while being scanned with functional magnetic resonance imaging in the resting state. We tested 0.5- and 100-Hz stimulation, using blocks of 22 sec “on” alternating with 22 sec of baseline (device was “off”). The primary outcome measure was differences in blood oxygen level dependent data associated with the device being on versus baseline. The secondary outcome measures were the effects of stimulation on connectivity within the default mode, sensorimotor, and fronto-parietal networks. Both 0.5- and 100-Hz stimulation resulted in significant deactivation in midline frontal and parietal regions. 100-Hz stimulation was associated with both increases and decreases in connectivity within the default mode network (DMN). Results suggest that CES causes cortical brain deactivation, with a similar pattern for high- and low-frequency stimulation, and alters connectivity in the DMN. These effects may result from interference from high- or low-frequency noise. Small perturbations of brain oscillations may therefore have significant effects on normal resting state brain activity. These results provide insight into the mechanism of action of CES, and may assist in the future development of optimal parameters for effective treatment

Differences between Physostigmine- and Yohimbine-induced States Are Visualized in Canonical Space Constructed from EEG during Natural Sleep-wake Cycle in Rats

Although quantitative EEG parameters, such as spectral band powers, are sensitive to centrally acting drugs in dose- and time-related manners, changes of the EEG parameters are redundant. It is desirable to reduce multiple EEG parameters to a few components that can be manageable in a real space as well as be considered as parameters representing drug effects. We calculated factor loadings from normalized values of eight relative band powers (powers of 0.5, 1.0~2.0, 2.5~4.0, 4.5~5.5, 6.0~8.0, 8.5~12.0, 12.5~24.5, and 25~49.5 Hz bands expressed as ratios of the power of 0.5-49.5 Hz band) of EEG during pre-drug periods (11:00~12:00) by factor analysis and constructed a two-dimensional canonical space (reference canonical space) by canonical correlation analysis. Eight relative band powers of EEG produced by either physostigmine or yohimbine were reduced to two canonical scores in the reference canonical space. While changes of the band powers produced by physostigmine and yohimbine were too redundant to describe the difference between two drugs, locations of two drugs in the reference canonical space represented the difference between two drug's effects on EEG. Because the distance between two locations in the canonical space (Mahalanobis distance) indicates the magnitude of difference between two different sets of EEG parameters statistically, the canonical scores and the distance may be used to quantitatively and qualitatively describe the dose-dependent and time-dependent effects and also tell similarity and dissimilarity among effects. Then, the combination of power spectral analysis and statistical analysis may help to classify actions of centrally acting drugs

Attitudes of Pulmonologists about Obstructive Sleep Apnea Syndrome and its Treatment in Izmir

Objective We aimed to evaluate pulmonary medicine physicians’ attitudes about obstructive sleep apnea syndrome (OSAS) and its treatment in Izmir. Materials and Methods About 78 of 120 pulmonary medicine physicians in Izmir answered the questionnaire containing 24 items (demographics: 6, education: 4, attitudes: 9, knowledge: 5). Results 67.9% of the participants were female. Mean age was 41.06±5.63, mean working year was 11.16±6.09. 52.6% worked in training and research hospitals, 32.1% in state hospitals, and the rest in private and university hospitals. Monthly patient number was 714.10±3.24, patients number with OSA symptoms was 14.85±2.15. 64.1% had completed speciality education in hospitals with sleep disorders centers and this ratio was higher in physicians whose working year was less than 10. 24.4% had practiced sleep study during this education. Participation in sleep study courses after speciality education was 48.7%. 26.9% worked as sleep specialist. 67.9% usually asked patients OSA symptoms and 38.5% asked preoperative OSA symptoms. 97.4% usually referred patients to sleep centers. 65.4% had been working in hospitals with sleep disorders centers. The ratio of correct answers in knowledge part of the questionnaire was 95%. Conclusion OSAS is a major pulmonary disease and it is important in order to find out the patients with OSA risk. 2.07% of patients in clinics have OSA symptoms. Physicians’ confidence in diagnosis is more than managing patients with OSA. Practical part of sleep study is not enough in speciality education. Asking OSA symptoms is not common in pre-operative examination

Evaluation of Sleep Related Breathing Disorders and Obstructive Sleep Apne Syndrome in Interstitial Lung Patients

Objective: Interstitial lung disease (ILD) may create sleep disturbances due to chronic disease-related stress, respiratory abnormalities and adverse effects of treatment. We aimed to determine the quality of sleep in ILD patients, and the incidence of Obstructive sleep apnea syndrome (OSAS) in these patients. Materials and Methods: Taken to this study were 52 patients who were followed up in our center due to ILD. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were applied to the patients. Spirometry and diffusion test were performed. Polysomnography (PSG) was performed to 27 patients whose ESS were more than or equal to 10. Results: Demographic characteristics, body mass index, spirometry and diffusion measurements, PSQI global score and the sub-components of it didn’t show difference according to ESS daytime sleepiness. Sleep quality of 44% of the patients was determined to be poor by PSQI. PSQI global score and sub-components weren’t correlated with apnea-hypopnea index, stage 1 latency, sleep efficiency and nocturnal desaturation (p>0.05) in 27 patients who underwent PSG. We observed increased stage 1 sleep and decreased stage 2-3 and rapid eye movement sleep. As nocturnal hypoxemia was seen arousals (p=0.000, r=0.698) increased. OSAS was diagnosed in 19 (70%) of subjects. Conclusion: Although ILD patients don’t have daytime hypoxemia; they may have nocturnal hypoxemia and OSAS, which may effect their sleep quality. Therefore ILD patients should be evaluated for daytime sleepiness, and sleep-related breathing disorders