Maintenance Electroconvulsive Therapy

Since the other treatment options did not meet the expectations in treatment resistant patients, maintenance electroconvulsive therapy (m-ECT) recently regained interest as a treatment option . Although it has long been applied as a treatment, studies of m-ECT lacks strong evidence for effectiveness, safety and the choice of application method because of problems regarding methodology, small sample sizes and scarcity of randomized, double-blind, controlled trials. Besides several points about treatment remains uncertain. Some of these troubled points are the selection of patients that will receive m-ECT, schedule and procedure of the application, the duration of the treatment, the assessment and follow-up of side effects and concomitant medication with drugs. Therefore, some guidelines recommended it for a particular group of patients and some rejected its application with a cautious consideration. The terminology, applications and rationales in different disorders, possible side effects and concomitant drug use are discussed in this review. Further studies with broader samples are needed to clarify the issues of effectiveness and adverse events in m-ECT

Multi-factorial Depressive Disorders Need Multi-dimensional Interventions

Depressive disorders are so frequent and disabling health conditions which have been inarguably accepted to be a public health concern [1]. Many drugs have been developed to treat depression, however the efficacy of the antidepressants are inadequate particularly for mild or moderate depression [2-4]. It is also mentioned that when considering the trials about the treatment effect of the antidepressants, you should be careful about the results because of reflecting a small proportion of the society [4]. Despite the methodological issues related to the controversial results about the antidepressant efficacy, a recent review showed that the antidepressant effects of the drugs persist in a six month period [5,6]

Psychological Effects of COVID-19 Pandemic in Dental Healthcare Workers

Objective: This study aimed to evaluate the mental health status of Dental Health Care Workers (DHCWs) in a dental emergency university clinic treating urgent patients during the pandemic. Materials and Methods: A hundred fifteen participants were selected from DHCWs who actively worked during the pandemic in a Dental Emergency Clinic of a university. Depression, anxiety and stress levels of participants were measured with the Depression-Anxiety-Stress Scale and their insomnia levels were assessed with the Insomnia Severity Index. Correlations between independent continuous and dependent variables tested with Spearman test. Mann-Whitney U and KruskalWallis tests were used used to evaluate possible effects of independent variables. The psychological data of the aerosol-generating treatment group were compared to the rest of the participants using Mann-Whitney U tests. In all tests alpha=0.05 significance level was set. Results: The rates of DHCWs scored above the cut-off points were 54% for depression, 40% for anxiety, 36% for stress and 40% for insomnia. Feeling negative emotions before the pandemic significantly interacted with all psychometric measurements. Younger age, feeling anxious about changing working conditions and/or obtaining personal protective equipment was correlated positively with stress points (p=0.035, p=0.008, p=0.007, respectively). A significant percentage of DHCWs presented high scores on depression, anxiety, stress and insomnia in this study. Conclusion: The authorities and healthcare executives must show programmed leadership and support for DHCWs during the COVID-19 outbreak. The integration of programs developed to mitigate stress among DHCWs recommended during the COVID-19 pandemic

The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients

WOS: 000399509400017PubMed ID: 28192770This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM IlI-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification

The common brain structures correlated with personality traits in healthy mothers and their daughters

Objective: To investigate the heritability of personality traits related to brain regions by recruiting a group of healthy mothers with their daughters. Methods: Twenty-two right handed mother-daughter pairs who gave their informed consents were included in this study. All of the participants were screened with non-patient Turkish version of Structured Clinical Interview for DSM IV (Diagnostic and Statistical Manual of Mental Disorders) to rule out any current and past psychiatric disorder. the volunteers filled the TCI (Temperament and Character Inventory) and underwent MRI (Magnetic Resonance Imaging) for brain imaging in consecutive days. the MRI scans of the participants were obtained during their follicular phase to control menstrual effect on brain volume. Image analysis was performed using SPM 8 software (Statistical Parametric Mapping) running in MATLAB 7. Image processing was based on the VBM-DARTEL (Voxel Based Morphometry) method. Age and total brain volume were included as confounding factors. To obtain common brain structures correlated with personality traits in both groups, group x personality dimension interaction analyses were performed. Results: the daughters had higher education years and they scored significantly higher NS (Novelty Seeking) points compared to their mothers. the correlation analyses revealed that HA (Harm Avoidance) in temperamental traits, SD (Self-Directedness) and ST (Self-Transcendence) in character traits were correlated significantly within mother-daughter pairs. the common brain structures which were significantly interacted in different personality traits were: Harm Avoidance: Positively interacted areas were right orbitofrontal cortex (BA 10) and left occipital cortex (BA 19), negatively interacted areas were left inferior frontal lobe (BA 45), left primary sensory cortex (BA 1), right amygdala, hypothalamus and cerebellum. Novelty Seeking: Positively interacted areas were left primary sensory cortex (BA 1) and the pole of left temporal lobe (BA 20). There was no negative interaction. Reward Dependence: There was only positively interacted areas which were left frontal lobe (BA 6, 8), right primary sensory area extended to motor areas (BA 3, 4), the pole of left temporal lobe (BA 20), the left inferior (BA 44) and the right middle frontal gyrus (BA 46). Persistence: There was only positively interacted areas which were bilateral ventral striatum and bilateral superior frontal gyrus at BA 6. Self-Directedness: There were only negative associations at the bilateral middle frontal gyrus (BA 6), right inferior frontal gyrus (BA 44), right precentral gyrus (BA 9) and posterior cingulate cortex. Cooperativeness: There was only one negative correlation at left superior temporal gyrus (BA 21). Self-Transcendence: There were only negative interactions at superior temporal gyrus (BA 22) bilaterally, left orbitofrontal cortex (BA 10) and right fusiform gyrus (BA 37). Conclusion: Despite of the limitations, the effect of inheritance related with different personality traits was shown on multiple candidate brain regions in this study. the overlapped brain regions with various personality traits suggest the involvement of these regions in different neural networks by multitasking

İlk atak depresyon hastalarında azalmış frontal korteks hacimleri

Objective: Brain imaging studies have shown that depressed individuals suffer from inadequate frontal lobefunctions vis ;agrave; vis smaller frontal lobes. The effects of depression's recurrent nature and long-term antidepressant treatment are not definitely known. This study aimed to examine frontal lobe volume at the onset of clinical depression by including first-episode drug-naive depressed patients. Method: The study included 23 first-episode drug-free major depression patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and 28 healthy age- and sex-matched controls. Cranial magnetic resonance (MR) images were obtained in both groups using a 1.5 Tesla device. Gray and white matter volumes in the frontal lobes were measured using the Medical Image Processing Analysis and Visualization (MIPAV) computer program. Results: Frontal gray matter volume in the patients was lower than that in the control group. White matter and total intracranial volume did not differ between the 2 groups. Small gray matter volume was not correlated with the duration or severity of illness. Conclusion: The results of this study indicate that frontal lobe gray matter volume is low in first-episode depressed patients and is independent of both illness severity and duration. This result suggests that the observed changes in the frontal lobe could have occurred before the clinical symptoms of depression were observed.Amaç: Beyin görüntüleme çalışmalarında depresif hastaların frontal alanlarında hacim küçüklüğü ve işlev kaybı olduğu bildirilmiştir. Tespit edilen bu hacim küçüklüğüne hastalığın yineleyici doğasının ve antidepresan ilaç kullanımının etkisi net olarak bilinmemektedir. Bu çalışma frontal lob hacim farklarının hastalığın başlangıcından beri var olabileceği varsayımını sınamak amacıyla ilk atak ve ilaçsız hastalarda gerçekleştirilmiştir. Yöntem: Çalışmaya ilk atak, psikotrop ilaç kullanmamış, Mental Bozuklukların Tanısal ve Sayımsal El Kitabı (DSM IV) kriterlerine göre major depresif bozukluk tanısı konulan 23 depresyon hastasıyla; yaş ve cinsiyet dağılımı bakımından denkleştirilmiş 28 sağlıklı kontrol olgusu alınmıştır. Kraniyal manyetik rezonans (MR) görüntüleri 1,5 Tesla MR cihazıyla elde edilmiştir. Gri ve beyaz madde hacimlerinin ölçümlerinde Medical Image Processing, Analysis, and Visualization (MIPAV) adlı bilgisayar yazılımı kullanılmıştır. Bulgular: Depresyon hastalarında kontrol grubuna göre frontal gri madde hacmi daha küçük bulunmuştur. Beyaz madde ve toplam kafa içi hacmi her iki grupta da benzer çıkmıştır. Bağlantı analizlerinde küçük frontal gri madde hacmiyle hastalığın süresi ve şiddeti arasında ilişki bulunmamıştır. Sonuç: Bu çalışmanın sonuçları ilk atak depresyon hastalarında frontal lob gri madde hacminin hastalık süresinden ve şiddetinden bağımsız bir şekilde küçük olduğunu göstermektedir. Bu sonuç, frontal loptaki değişikliğin depresyonun klinik belirtilerin izlenmesinden önce başlamış olabileceğine işaret etmektedir