Sexual functions and prolactin levels in patients with bipolar disorder

Objective: Mood stabilizers and antipsychotic drugs are known to have adverse effects on sexual function. However, patients often refrain from speaking about sexual complaints that may cause dose reduction and discontinuation of the drug without medical supervision. In this study we aimed to evaluate sexual functions of patients with bipolar disorder in remission period, considering prolactin levels and medications. Method: We recruited 52 patients with bipolar disorder in remission according to DSM-IV diagnostic criteria. Prolactin levels were measured in all patients. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was used to assess sexual dysfunction. Results: Mean prolactin levels were 24.71 ± 4.25 and 19.96 ± 5.52 ng/ml respectively for females and males. Patients taking mood stabilizer (MS) and mood stabilizer plus antipsychotic (AP) treatment had different prolactin levels (p<0.001). Total GRISS scores were not different for MS and MS+AP treatment groups. We didn't find a correlation between Total GRISS scores and prolactin levels. There was a significant deterioration in female non-sensuality, female dissatisfaction and anorgasmia subscales of female patients and significant deterioration in premature ejaculation, impotence and male dissatisfaction subscales of male patients. Discussion: In our sample, both men and women patients with bipolar disorder in remission have sexual dysfunctions. Our results suggest that prolactin levels are not sufficient to demonstrate the sexual dysfunction. To enhance patient compliance it is necessary to focus more on sexual symptoms of patients receiving MS and AP treatment

Autonomic Cardiac Activity in Patients with Smoking and Alcohol Addiction by Heart Rate Variability Analysis

Purpose: Smoking and alcohol addictions are common and worldwide. In the present study, we aimed to investigate the effects of these addictions on cardiac rhythm using heart rate variability (HRV) analysis. Methods: Addicts (n=42 men: 22 cigarette; 20 cigarette and alcohol) and age-matched controls (n=34 men) were included in the study. All patients fulfill the criteria for dependence according to DSM-IV-TR. Electrocardiography (ECG) recordings were obtained for a total of 30 minutes. Fagerstrom Nicotine Addiction Test (FNAT) and CAGE questionnaire (Cut down, Annoy, Guilt, Eye opener) was applied to all patients. Results: Almost all HRV parameters were significantly decreased in cigarette and cigarette and alcohol addicts compared with controls (

Reversible cycloplegia caused by duloxetine: a case report

A Duloxetine is a balanced and potent dual reuptake inhibitor of serotonin and norepinephrine (SNRI) that has previously been shown to be effective in the treatment of major depressive disorder (MDD), generalized anxiety disorder, and diabetic peripheral neuropathic pain (DPNP). Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Here, we present a reversible cycloplegia case caused by duloxetine use. The patient was a 24 years-old woman with MDD diagnosis. Patient had somatic symptoms like fatigue, myalgia, and headache, besides her depressive symptoms for the last two months. Escitalopram and sertraline were used for her MDD before and she had to quit both owing to side effects such as nausea and drowsiness. Duloxetine 30mg/day treatment was started in our outpatient clinic. In her first follow-up exam, she reported light sensitivity and increased visual impairment. The visual impairment led dizziness and an increase in headache. She was consulted to ophthalmology unit of our hospital and cycloplegia was detected in her eye examination. Duloxetine was stopped in the ninth day of treatment but cycloplegia negatively affected the patient's daily life for almost 4 weeks and impaired her functionality. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects. Eye pain, changes in vision and swelling or redness in or around the eye are mentioned as possible visual side effects in the medication of duloxetine. The ocular and visual side effects from a patient's systemic medication can range from mild to severe. These side effects may or may not be serious enough to warrant discontinuing treatment. Cycloplegia seems as a rare adverse effect in antidepressant treatment and may take a long time to wash out. Recognition of ocular and visual side effects is important to prevent and minimize serious complications. In such visual disturbances, eye examination of the patient should be performed and the responsible drug should be discontinued as early as possible

Thiol/Disulfide Homeostasis in Bipolar and Unipolar Depression

Objective: Bipolar disorder and unipolar depressive disorder are complex phenotypes. There appear to be phenotypical, mechanistic, and therapeutic differences between bipolar depression (BD) and unipolar depression (UD). There is a need for understanding the underlying biological variation between these clinical entities. The role of oxidative processes underlying bipolar disorder and depression has been demonstrated. Thiol-disulfide homeostasis (TDH) is a recent oxidative stress marker. In this study, we aimed to inspect patients with bipolar depression and unipolar depression in terms of thiol-disulfide balance and to compare them with healthy controls. Methods: Patients admitted to the outpatient clinic of Ankara Numune Training and Research Hospital and diagnosed either as a depressive episode with bipolar disorder (n = 37) or unipolar depression (n = 24) according to DSM-5 criteria, along with healthy controls (HC) (n = 50), were included in the study. Native thiol, total thiol, and disulfide levels were compared across the groups. Results: In comparison to HC, both BD and UD groups had higher disulfide levels, disulfide/native thiol ratio, and disulfide/total thiol ratio. No significant differences between BD and UD were detected in terms of disulfide level, disulfide/native thiol ratio, and disulfide/total thiol ratio. Conclusion: Increased levels of disulfide, native thiol, and disulfide/total thiol ratios compared to healthy controls in both UD and BD groups may be indicative of the presence of oxidative damage in these two clinical conditions. To clarify the role of oxidative stress in the pathophysiology of depressive disorders and investigate TDH, longitudinal studies in patients with medication-free UD and BD are required

Serum glial cell line-derived neurotrophic factor levels and impulsivity in heroin addiction: a cross-sectional, case-control study of 129 heroin addicts

OBJECTIVE: Glial cell line-derived neurotrophic factor (GDNF), being a protective of dopaminergic neurons, is reported to modulate addictive behaviours and have a role as a negative regulator for biochemical and behavioural adaptations to drug abuse. We aimed to reveal impulsivity and serum GDNF levels in patients with heroin addiction and investigate their relationships in order to contribute to the understanding of behavioural aspects and biological mechanisms in heroin addiction via this study. METHODS: This study was performed at the Department of Psychiatry of Ankara Numune Training and Research Hospital, Turkey. We recruited 129 heroin-dependent patients and 90 age, sex, and smoking-matched healthy controls with no major psychopathology. Barratt Impulsivity Scale-11, Hospital Anxiety and Depression Scale (HADS) and sociodemographic data form were applied to all participants. Laboratory analysis for serum GDNF levels was performed for each participant's blood sample. RESULTS: Total impulsivity scores and scores of Attentional Impulsivity, Motor Impulsivity, and Unplanned Impulsivity subscales were all higher in heroin addicts compared to the controls. Heroin addicts had also lower serum GDNF levels and lower GDNF levels were associated with high impulsivity and high HADS scores in heroin addicts. CONCLUSION: Decrement in GDNF levels in heroin addiction seems as to be an important data which could be associated with impulsivity, anxiety, and depressive symptoms. GDNF could find a prominent place among the target molecules in the treatment of heroin addiction