Bipolar Disorder and Diabetes Mellitus

Comorbid endocrine and cardiovascular situations with bipolar disorder usually result from the bipolar disorder itself or as a consequence of its treatment. With habits and lifestyle, genetic tendency and side effects, this situation is becoming more striking. Subpopulations of bipolar disorders patients should be considered at high risk for diabetes mellitus. The prevalence of diabetes mellitus in bipolar disorder may be three times greater than in the general population. Comorbidity of diabetes causes a pathophysiological overlapping in the neurobiological webs of bipolar cases. Signal mechanisms of glycocorticoid/insulin and immunoinflammatory effector systems are junction points that point out the pathophysiology between bipolar disorder and general medical cases susceptible to stress. Glycogen synthetase kinase (GSK-3) is a serine/treonine kinase and inhibits the transport of glucose stimulated by insulin. It is affected in diabetes, cancer, inflammation, Alzheimer disease and bipolar disorder. Hypoglycemic effect of lithium occurs via inhibiting glycogen synthetase kinase. When comorbid with diabetes, the other disease -for example bipolar disorder, especially during its acute manic episodes-, causes a serious situation that presents its influences for a lifetime. Choosing pharmacological treatment and treatment adherence are another important interrelated areas. The aim of this article is to discuss and review the etiological, clinical and therapeutic properties of diabetes mellitus and bipolar disorder comorbidity

Epilepsy and Mood Disorders

Mood disorders are the most common psychiatric comorbid disorder that affects quality of life and prognosis in epilepsy. The relation between depression and epilepsy is bidirectional. Not only the risk of having a depression among epilepsy cases is more than the healthy control cases, but also the risk of having epilepsy among depressive cases is more than the healthy control cases. People diagnosed with epilepsy are five times more likely than their peers to commit suicide. Moreover it seems that some epilepsy types like temporal lobe epilepsy have a much higher risk (25 times) for suicide. Risk of suicide in epilepsy, which is independent from depression, increases more with the presence of depression. The common pathway between epilepsy, depression and suicide is hypofrontality and irregularity of serotonin metabolism. Contrary to depression, data on relationship between bipolar disorder and epilepsy is limited. However, mood disorder, mixed episodes with irritable character and mania are more frequent than assumed. As a matter of fact, both disorders share some common features. Both are episodic and can become chronic. Kindling phenomenon, irregularities in neurotransmitters, irregularities in voltage gate ion channels and irregularities in secondary messenger systems are variables that are presented in the etiologies of both disorders. Anticonvulsant drugs with mood regulatory effects are the common points of treatment. Understanding their mechanisms of action will clarify the pathophysiological processes. In this article, the relationhip between epilepsy and mood disorders, comorbidity, secondary states and treatment options in both cases have been discussed

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

ARTICLE IN PRESS Turkish Journal of Psychiatry 2012 Aphasia, Prosopagnosia and Mania: A Case Diagnosed with Right Temporal Variant Semantic Dementia 2

SUMMARY Neurologic disorders can produce "secondary" mania, and clinicians must distinguish secondary mania from bipolar disorders (BD). Patients with new and late onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. Neurologic causes of mania include strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington's disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal lobar degeneration. The term Frontotemporal Lobar Degeneration (FTLD) is suggested for neurodegenerative diseases characterized by focal degeneration such as Primer Progressive Aphasia (PPA), Frontal Lobe Dementia, PPA-Amyotrophic Lateral Sclerosis (ALS), and Corticobasal Degeneration. In this article, we report a frontotemporal dementia (FTD) case that referred with manic symptoms. The female patient was 46 years old, married, graduated from primary school, and had been admitted with complaints of hyperactivity, excessive talking, and decreased sleep for one week. She presented first with complaints that began three years ago that included the inability to remember names, recognize faces, use household appliances, and follow rules. She had also been repeating the same words and behaviors. Prosopagnosia, aphasia, and a positive family history of ALS were discussed with related index in our case

Dokuz Tip Mizaç Ölçeği'nin Geçerlik ve Güvenirliği

The aim of this study is to develop a scale compatible with the Nine Types Temperament Model (NTTM), which did not have any prior measurement tools to scientifically prove its reliability and validity. NTTM is created by re-evaluating the Enneagram System –a system that defines nine personality types- used for analyzing and comprehending ego mechanisms. Nine Types Temperament Scale (NTTS) which is a self-rated instrument composed of 91 items with three-point Likert type was developed from this model and applied to 990 participants. Confirmatory factor analyses were carried out in order to evaluate whether the scale fits to the model related to the temperament model. In exploratory factor analyses of the scale eigen values of nine factors vary between 8.089 and 1.661, and represent 39.04% of the total variance. In confirmatory analyses of the scale CFI value is 0.88, GFI value is 0.845, IFI value is 0.88 and RMSEA value is 0.054. Test-retest reliability of the scale was evaluated with 46 participants. Cronbach alpha value of the whole scale is 0.75, while Cronbach alpha values for every temperament type were calculated as 0.77, 0.79, 0.68, 0.71, 0.80, 0.74, 0.71, 0.83 and 0.77 respectively. Concurrent validity was performed with Cloninger's TCI (Temperament and Character Inventory) and Akiskal's TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire Version). The types of NTTM showed significant correlations with TCI and TEMPS-A. Results of the study support that NTTS is a reliable and valid scale.Bu çalışmada, benlik mekanizmalarını dokuz kişilik tipi ile açıklayan Enneagram Sistemi'nin yeniden yorumlanması ile oluşturulan ve günümüzde geçerlik ve güvenirliği bilimsel açıdan kanıtlanmış bir ölçüm aracı bulunmayan Dokuz Tip Mizaç Modeli (DTMM) ile uyumlu bir ölçek geliştirilmesi amaçlanmıştır. 91 maddeden oluşan ve üçlü Likert tipi bir öz bildirim ölçeği olan Dokuz Tip Mizaç Ölçeği (DTMÖ) 990 üniversite öğrencisine uygulanmıştır. Ölçeğe uygulanan açıklayıcı faktör analizlerinde dokuz faktörün öz değerleri 8.08 ve 1.66 arasında değişmekte ve toplam varyansın %39.04'ünü temsil etmektedir. Ölçeğin modele uygunluğunu saptamak için doğrulayıcı faktör analizi uygulanmıştır. Ölçeğin doğrulayıcı faktör analizi sonuçlarına göre CFI değeri 0.88, GFI değeri 0.845, IFI değeri 0.88 ve RMSEA değeri 0.054'tür. Ölçeğin test-tekrar test güvenirliği 46 katılımcıyla sınanmıştır. Ölçeğin tümü için Cronbach alfa değeri 0.75, tipler için sırasıyla 0.77, 0.79, 0.68, 0.71, 0.80, 0.74, 0.71, 0.83, 0.77’dir. Ölçeğin eş zamanlı geçerliği Cloninger'in MKE (Mizaç ve Karakter Envanteri) ve Akiskal'in TEMPSA( Temparement Evaluation of Memphis, Pisa, Paris and San Diego- Autoquestionnaire) ölçekleriyle sınanmıştır. DTMM'deki tipler TCI ve TEMPS-A ile anlamlı bağıntılar göstermiştir. Araştırmanın sonuçları DTMÖ'nün geçerli ve güvenilir bir ölçek olduğunu desteklemektedir

Bipolar Disorder and Cancer

Prevalence studies and studies on causation relations have shown that the relation between psychiatric disorders and chronic physical diseases is neglected. For heterogeneous diseases an increasing number of susceptibility variants are being defined. Alzheimer disease, bipolar disorder, breast and prostate cancer, coronary artery disease, Chron's disease, systemic lupus eritematosus, type 1 and type 2 diabetes mellitus are mentioned together with epigenetic concept. In acrocentric zone of chromosome 13, breast cancer, retinoblastoma, chronic Iymphocytic leukemia genes with B cells, dopamin loci of bipolar disorder are found together. Among bipolar and healthy individuals, an increase risk of breast cancer in female cases has been resported. On the other hand, psychosocial factors that affect stress and response to stress itself may be important variables in prognosis and progression of different cancer types. During the course of many cancer types –especially brain tumors- and during treatment of chemotherapeutic agents, bipolar symptomatology may appear. In this article, it is reviewed with relevant literature that whether an etiological relation between bipolar disorder and cancer exist and how both diseases affect each other's course and treatment

Late onset schizophrenia: a review

A consensus was reached by International Late Onset SchizophreniaGroup that cases in which onset occurs between 40 and 60 be calledlate onset schizophrenia and that cases in which onset occurs afterage 60 should be called very late onset schizophrenia like psychosis.Inconsistencies in diagnostic systems and nomenclature, coupledwith a tendency among most schizophrenia researchers to ascribelate onset psychoses to organic factors, have led to such casesoccupying an ambiquous position in relation to schizophrenia. Interms of epidemiology, symptom profile and identifiedpathophysiologies, the diagnoses of late onset schizophrenia haveface validity and clinical utility. General adoption of these categorieswill foster systematic investigation of such patients. Bothdevelopmental and degenerative processes that affect specific braincircuitry have been implicated and intensive study of late onsetpatients may ultimately shed light on etiology. The purpose of thisnomenclature is to clarify the position of these patients and tostimulate more research

Duygudurum Dengeleyici Uyum Anketi: Geçerlilik ve Güvenilirlik Çalışması

Amaç: Bu çalışmanın amacı, iki uçlu bozukluk ve duygudurum dengeleyici ilâçlarla ilgili görüş ve inanışları sorgulayan Duygudurum Düzenleyici Uyum Anketinin (DDUA) güvenilirliğini ve geçerliliğini test etmektir. Yöntem: 33 maddeli anket formu, DSM-IV’e göre iki Uçlu Bozukluk tanılı, iyilik dönemindeki 200 hastaya uygulanmıştır. İç tutarlılık cronbach alpha ile test edilmiştir. Yapısal geçerlik için faktör analizi uygulanmıştır. Bulgular: DDUA, doktor-hasta ilişkinin algılanması, duygudurum dengeleyicileri hakkında inançlar, genelde korunmuş özerklik, duygudurum dengeleyicinin dozunu ayarlamada korunmuş özerklik alt boyutlarında iyi ve kabul edilebilir bir iç tutarlılığa sâhiptir ve faktör analizi 4 alt boyutu işaret etmektedir. Tartışma ve Sonuç: DDUA olumlu psikometrik özelliklere sâhiptir. Gelecekteki çalışmalar DDUA’nin tedavi uyumundaki öngörücülüğünü araştırmaya yönelik olmalıdır

Primary Enuresis Nocturna in Adult

Enürezis, tekrarlayıcı nitelik taşıyan idrar kaçırmadır. Beş yaşından önce kontinans kazanılıp kazanılmamasına göre primer ve sekonder olarak, geceleri olursa nokturnal, gündüz de eklenirse diurnal olarak sınıflandırılır. Enürezis nokturnanın DSM-IV-TR' de bahsedilen yaygınlığı 5 yaş çocuklarda erkekler için %7 ve kızlar için %3 olarak belirtilmektedir. Onsekiz yaşa gelindiğinde ise erkeklerin sadece %1'i, kızların ise daha az bir kısmı hala altını ıslatmaya devam etmektedir. Enürezisin oluş nedenleri arasında, uygun olmayan tuvalet eğitimi, kötü yaşam koşulları, düşük sosyo-kültürel düzey, üriner enfeksiyonlar, uyku bozuklukları, spina bifida ve diyabet sayılabilir. Ayırıcı tanıda tüm bu etkenler gözden geçirilmeli ve organik patoloji dışlanmalıdır. Erken tanı konup tedavi edilmeyen olgularda erişkin yaşlara kadar sürebilen bu hastalık beraberinde çeşitli psikiyatrik bozuklukların ortaya çıkmasına ve tedavinin güç hale gelmesine neden olabilir. Enürezis çocukluk çağında tedavi edilmediğinde, erişkinde özgün, karmaşık ve psikosomatik bir görüngüdür. Bu yazıda erken tanı almış olsa da, tedavideki aksamalar nedeniyle tam bir düzelme sağlanamamış, 22 yaşında, kadın, enüretik bir olgu tartışılmaktadır. Olgu yineleyen depresif dönemleri nedeniyle eğitimini yarıda bırakmış, karşı cins ile dönemine uygun ilişkiler geliştirememiştir. Bu olgu bildiriminin amacı tedavi edilmeyen birincil enürezis nokturnanın, erişkin çağda ortaya çıkardığı ilişki sorunları ile eştanılı birinci eksen psikopatolojilere dikkati çekmektir

Reproductive Hormones and Mood Disorders

During the menstrual cycle, pregnancy and breast-feeding periods, as well as in menopausal and post-menopausal periods, the physiological and psychological processes that change according to the hormonal fluctuations influence every women similarly and each one differently. These physiological processes are controlled by neuroendocrine sequences, of which the hypothalamo-pituitary-adrenal axis and the hypothalamo-pituitary-gonadal axis are the most important ones. The hypothalamo-pituitary-gonadal axis affects mood, anxiety, cognition and pain. The interaction of these hormones with mood and behavior is bidirectional. The differences in phenomenology and epidemiology of mood disorders with regards to gender can be explained with the effects of hormones. All of the periods mentioned above are related with mood disorders at terms of risk factors, disease symptoms, progress of disease and response to treatment. Epidemiologic data supports the relationship between the mood disorders and reproductive processes. The prevalence of major depression increases in women with the menarche and ceases in post- menopausal period. Similarly, the initial symptoms of bipolar disorder begins around the menarche period in 50% of the cases. Despite proper treatment, some female patients with major depression experience recurrence during the premenstrual period of their menstrual cycles. The conformity and change in a woman’s brain during pregnancy is controlled dominantly by the neuroendocrine systems, while it is controlled by the external stimuli actively related to the baby during nursing period. The changes that occur are closely related to postpartum mood disorders. Again, all the changes and suspension of medication during this procedure are risk factors for early depressive and dysphoric situations. Variables of a wide range, from follicle stimulating hormone, melatonin, and sleep to body mass index interact with mood disorders in menopausal and post-menopausal periods. Interest on the effects of gonadal steroids on the central nervous system has grown parallel with our increasing knowledge. In the last decade, the place of hormonal treatments in the treatment of mood disorders have been discussed continously. During this period, along with the anti-depressant efficacy of estrogen, anti-manic efficacy of tamoxifen was also demonstrated in several studies. In this paper, the complex relationship between the physiological changes and the mood disorders during a menstrual cycle, pregnancy, nursing, menopausal and post-menopausal periods are briefly reviewed and discussed over the reproductive hormones in the context of etiology, phenomenology and treatment