Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Objective: This study aimed to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation (p-TENS) in children with detrusor overactivity (DO) who were subjected to standard medical treatment, urotherapy, and/or biofeedback. Materials and Methods: Thirty-two children (female: 17, male: 15) underwent p-TENS because of refractory lower urinary tract dysfunction symptoms between 2017 and 2019. Children with neurogenic bladder (n=7) and dysfunctional voiding (n=13) were excluded. The data of 12 children diagnosed with DO after the urodynamic study (boys: 8, girls: 4), were evaluated for treatment response 6 months after the last session. p-TENS was performed using S2-3 dermatome 2 days a week for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated a pulse of 250 μs. Results: The median age of 12 children was 11 years (interquartile range 25-75, range: 9.5-12.5). Incontinence is the main complaint. Significant improvement in uroflow parameters was detected in all children. Urgency, urge incontinence (p=0.016), and constipation (p=0.031) rates were significantly decreased. Voiding dynamics revealed improved voiding patterns (pre/post tower shaped pattern; n=7 vs. n=2), and incontinence was completely resolved in nine children (75%). Conclusion: P-TENS has emerged as a therapeutic alternative in children with DO refractory to standard treatment protocol and medication

The Relationship Between the Duration of Drug Use and the Bipolar Disorder Patients' Sociodemographic and Clinical Characteristics

WOS: 000337335600004PubMed: 24936756Objective: The purpose of this study was to determine the duration of psychotropic drug use in the long-term follow-up of bipolar disorder (BD) patients. In addition, this study aimed to investigate their role in the daily clinical practice in association with patient sociodemographic and clinical characteristics. The overarching goal for this study was to produce results that enlighten the development of new treatment strategies. Method: Follow-up data acquired from the Psychiatry Department of Uludag University Faculty of Medicine was used to retrospectively evaluate 151 patients diagnosed with BD. Socio-demographic data of the patients and information regarding the disease and the drugs used were analyzed. Results: Of the patients studied, 57.0% were female with a mean age of 41.5 +/- 12.8. The mean duration of follow-up was 1985.3 +/- 1933 [median 1291 (15-9135)] days; euthymic period accounted for 86.0% of this duration. Interestingly, incompliance with the treatment triggered the switch to mania and ineffective treatment triggered the switch to depression. Medication distribution was as follows: 95.4% of the patients received antipsychotic and mood stabilizer treatments, 3.3% received only mood stabilizer treatment, and 1.30% received only antipsychotic treatment. The major findings of this study was that many sociodemographic as well as clinical manifestations including, early onset (aged <= 18 years), unmarried, first episode of mania, those with disease not showing seasonal features, psychotic symptoms, history of hospitalization, and higher number of manic or hypomanic episodes resulted in increased patient prescribed antipsychotic drugs Conclusion: Our data suggests that antipsychotic drugs are being used more frequently and for longer durations in the treatment of BD

The effect of residual symptoms on clinical characteristics and functioning of patients with bipolar disorder in remission

WOS: 000325901500007Amaç: Bu çalışmada düzelme döneminde olan bipolar bozukluk (BB) hastalarının kalıntı belirtilerinin, hastanın sosyodemografik, klinik ve tedavi özellikleriyle ilişkisi ve işlevselliğe etkisinin araştırılması amaçlanmıştır. Yöntem: Çalışma grubunu düzelme döneminde olan ve çalışmaya alınma ölçütlerini karşılayan BB hastaları oluşturmuştur. Hastalar kesitsel olarak tek bir görüşme ile değerlendirilmiştir. Sonuçlar: Çalışmaya toplam 120 hasta (%54.2 kadın) alınmıştır. Hiç evlenmemiş olanlarda manik kalıntı belirtilerin, evli ve boşanmış/dul olanlara göre anlamlı düzeyde daha yüksek olduğu saptandı. Evli olan grubun ise İşlevselliğin Genel Değerlendirilmesi Ölçeği (İGD) puanının, hiç evlenmemiş ve boşanmış/dul olanlara göre anlamlı düzeyde daha yüksek olduğu saptandı. Çalışanların İGD puanı işsiz, ev kadını ve emekli olanlara göre anlamlı düzeyde daha yüksek çıktı. Depresif kalıntı belirtilerin ve bozukluğun erken yaşta başlamasının işlevsellik üzerine olumsuz etkisinin daha belirgin olduğu, geçirilen son atağın kalıntı depresif ve buna eşlik eden anksiyete belirtileri üzerine etkisinin bulunduğu, hastaların düzenli hekim izlemesine gelmesini sağlayan nedenlerin daha çok depresif belirtiler ve genel işlevsellik düzeyinin düşüklüğünün olduğu saptanmıştır. Hastaların sadece %23.4’ünün tek bir duygudurum dengeleyici ile izlendiği, %75’Inin ise en az iki ilaç kullandığı saptandı, ancak hastaların kullandıkları tedavi ile kalıntı belirtiler ve işlevsellik durumu arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Tartışma: BB’nin, psikososyal işlevselliği önemli derecede etkilemesi nedeniyle hastalığın özelliklerini belirlemek, düzenli ve sürekli olarak izlemek ve tedavisini planlamak günümüzde önem kazanmaktadır. Kalıntı belirtilerin içeriğini belirleyen ve kalıntı belirtilerle birlikte işlevselliğe katkıda bulunan birçok değişken, BB hastalarının homojen bir grup oluşturmalarını ve benzer bir prognoz göstermesini engelleyen etkenlerdendir. Bu bağlamda her BB hastasına özgü farklı bir tedavi stratejisi geliştirilmesinin önemi ortaya çıkmaktadır. (Anadolu Psikiyatri Derg 2013;14:228-36)Objective: The objective of this study was to investigate the relationship between the residual symptoms of patients with bipolar disorder (BD) in remission and their sociodemographic, clinical and treatment-related characteristics and their effect on functioning. Methods: The study group consisted of BD patients who were in remission and met the inclusion criteria of the study. The patients were assessed in a single cross-sectional interview. Results: A total of 120 patients (54.2% women) were included in the study. Those who never got married had significantly more manic residual symptoms than those who were married and divorced/widowed. The Global Assessment of Functioning (GAF) scores of the married group were significantly higher than those of the patients who never got married and were divorced/widowed. The GAF scores of those employed came out to be signifi-significantly higher than those of the unemployed, housewives and retired. Depressive residual symptoms and having the disease at a younger age had more prominent negative effects on functioning, the last attack experienced had an impact on the residual depressive symptoms and the accompanying anxiety symptoms, and the reasons that made the patients to come to regular doctor monitoring were mostly depressive symptoms and the decline in general functioning. Only 23.4% of the patients were monitored with a single Mood Stabilizer and 75% of them used at least 2 medications, but no statistically significant relationship was found between the treatment received by the patients and their residual symptoms and functioning. Conclusion: Since BD affects psychosocial functioning to a large extent, it is becoming increasingly important today to identify the characteristics of the disease, to monitor patients regularly and continuously, and to plan their treatment. Many variables that determine the nature of residual symptoms and contribute to functioning alongside residual symptoms are factors that prevent BD patients from forming a homogeneous group and demonstrating a similar prognosis. This makes it important to develop a different treatment strategy specific to each BD patient. (Anatolian Journal of Psychiatry 2013;14:228-36

The effect of residual symptoms on clinical characteristics and functioning of patients with bipolar disorder in remission

WOS: 000325901500007Amaç: Bu çalışmada düzelme döneminde olan bipolar bozukluk (BB) hastalarının kalıntı belirtilerinin, hastanın sosyodemografik, klinik ve tedavi özellikleriyle ilişkisi ve işlevselliğe etkisinin araştırılması amaçlanmıştır. Yöntem: Çalışma grubunu düzelme döneminde olan ve çalışmaya alınma ölçütlerini karşılayan BB hastaları oluşturmuştur. Hastalar kesitsel olarak tek bir görüşme ile değerlendirilmiştir. Sonuçlar: Çalışmaya toplam 120 hasta (%54.2 kadın) alınmıştır. Hiç evlenmemiş olanlarda manik kalıntı belirtilerin, evli ve boşanmış/dul olanlara göre anlamlı düzeyde daha yüksek olduğu saptandı. Evli olan grubun ise İşlevselliğin Genel Değerlendirilmesi Ölçeği (İGD) puanının, hiç evlenmemiş ve boşanmış/dul olanlara göre anlamlı düzeyde daha yüksek olduğu saptandı. Çalışanların İGD puanı işsiz, ev kadını ve emekli olanlara göre anlamlı düzeyde daha yüksek çıktı. Depresif kalıntı belirtilerin ve bozukluğun erken yaşta başlamasının işlevsellik üzerine olumsuz etkisinin daha belirgin olduğu, geçirilen son atağın kalıntı depresif ve buna eşlik eden anksiyete belirtileri üzerine etkisinin bulunduğu, hastaların düzenli hekim izlemesine gelmesini sağlayan nedenlerin daha çok depresif belirtiler ve genel işlevsellik düzeyinin düşüklüğünün olduğu saptanmıştır. Hastaların sadece %23.4’ünün tek bir duygudurum dengeleyici ile izlendiği, %75’Inin ise en az iki ilaç kullandığı saptandı, ancak hastaların kullandıkları tedavi ile kalıntı belirtiler ve işlevsellik durumu arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Tartışma: BB’nin, psikososyal işlevselliği önemli derecede etkilemesi nedeniyle hastalığın özelliklerini belirlemek, düzenli ve sürekli olarak izlemek ve tedavisini planlamak günümüzde önem kazanmaktadır. Kalıntı belirtilerin içeriğini belirleyen ve kalıntı belirtilerle birlikte işlevselliğe katkıda bulunan birçok değişken, BB hastalarının homojen bir grup oluşturmalarını ve benzer bir prognoz göstermesini engelleyen etkenlerdendir. Bu bağlamda her BB hastasına özgü farklı bir tedavi stratejisi geliştirilmesinin önemi ortaya çıkmaktadır. (Anadolu Psikiyatri Derg 2013;14:228-36)Objective: The objective of this study was to investigate the relationship between the residual symptoms of patients with bipolar disorder (BD) in remission and their sociodemographic, clinical and treatment-related characteristics and their effect on functioning. Methods: The study group consisted of BD patients who were in remission and met the inclusion criteria of the study. The patients were assessed in a single cross-sectional interview. Results: A total of 120 patients (54.2% women) were included in the study. Those who never got married had significantly more manic residual symptoms than those who were married and divorced/widowed. The Global Assessment of Functioning (GAF) scores of the married group were significantly higher than those of the patients who never got married and were divorced/widowed. The GAF scores of those employed came out to be signifi-significantly higher than those of the unemployed, housewives and retired. Depressive residual symptoms and having the disease at a younger age had more prominent negative effects on functioning, the last attack experienced had an impact on the residual depressive symptoms and the accompanying anxiety symptoms, and the reasons that made the patients to come to regular doctor monitoring were mostly depressive symptoms and the decline in general functioning. Only 23.4% of the patients were monitored with a single Mood Stabilizer and 75% of them used at least 2 medications, but no statistically significant relationship was found between the treatment received by the patients and their residual symptoms and functioning. Conclusion: Since BD affects psychosocial functioning to a large extent, it is becoming increasingly important today to identify the characteristics of the disease, to monitor patients regularly and continuously, and to plan their treatment. Many variables that determine the nature of residual symptoms and contribute to functioning alongside residual symptoms are factors that prevent BD patients from forming a homogeneous group and demonstrating a similar prognosis. This makes it important to develop a different treatment strategy specific to each BD patient. (Anatolian Journal of Psychiatry 2013;14:228-36

The efficacy of flupenthixol decanoate in bipolar disorder patients who have no sufficient remission with existing treatments

WOS: 000356969000009Objective: It is aimed to evaluate the prophylactic effect of flupenthixol decanoate in remitted BD patients. Methods: Remitted patients with bipolar disorder (BD), who had at least one mood episode each year in the last five years in spite of adequate pharmacotherapy, were included. Flupenthixol decanoate 20 mg/ml was administered in every two weeks. Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Bipolar Disorder Functioning Questionnaire (BDFQ), General Assessment of Functionality (GAF) and Side Effect Rating Scale (UKU) were applied. Patients were followed up for 12 months. Results: Eight patients with a mean age of 34.7 +/- 7.5 were enrolled to the study. None of the patients were under monotherapy before the study enrollment. Three (37.5%) of the three patients were dropped out. The data of remaining 5 patients' were evaluated. At the end of the study mean number of mood episodes declined to 0.2 +/- 0.4 per year indicating a statistical significance and the mean score of BDFQ declined to 119.6 +/- 2.7. Conclusions: Flupenthixol decanoate significantly improved functionality and decreased the number of mood episodes allowing an alternative treatment even in remitted BD patients

Prediction of depression in schizophrenia: Can serum levels of BDNF or EGF help us?

Today, it is known that the levels of neurotrophic factors alter in neuropsychiatric disorders such as major depressive disorder (MDD), schizophrenia, Alzheimer's disease or Parkinson's disease. In recent years, some studies demonstrated that MDD may occur as a result of the changes in neuronal plasticity at structural and molecular levels. © 2014, Ebru Oztepe Yavasci et al

Can BDNF and IL-2 be indicators for the diagnosis in schizophrenic patients with depressive symptoms?

WOS: 000344995200005PubMed: 25241757Objective: The aim of the current study is to determine whether serum levels of brain-derived neurotrophic factor (BDNF) and interleukin-2 (IL-2) can be biological indicators for the diagnosis of schizophrenia in patients with depressive symptoms. Method: Forty-seven patients (11 patients diagnosed with schizophrenia, 16 patients diagnosed with schizophrenia and comorbid depression and 20 patients diagnosed with major depressive disorder) and 20 healthy subjects were enrolled. The Positive and Negative Symptoms Scale, the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale were used for assessment. The serum BDNF and IL-2 levels of all the subjects were studied. Results: Decreased levels of serum BDNF and increased levels of serum IL-2 were found in the patients diagnosed with either schizophrenia, schizophrenia with depression, or major depressive disorder (p = 0.049, p = 0.010; p = 0.001 and p = 0.044; p = 0.027, p = 0.003; respectively) compared with control group. There were no significant differences between the patient groups in their serum BDNF and IL-2 levels. Conclusions: The present study suggests that neurotrophic factors and immune system changes are involved in the pathogenesis of schizophrenia with or without depressive symptomatology. However, the data do not clarify whether depressive symptoms in schizophrenia occur as a dimension of schizophrenia or as symptoms of major depression that is comorbid with schizophrenia

Kronik Uykusuzluğu Olan Distimik Kadınlarda Epworth Uykululuk Ölçeğinin ve Polisomnografinin Değerlendirilmesi

OBJECTIVE: In patients with dysthymic disorder (DD), sleep problems are assessed as a part of their depressive state, and different treatable conditions, such as other primary sleep disorders, are often skipped. We aimed to determine symptoms related to daytime sleepiness and polysomnographic findings in dysthymic women with chronic insomnia and to find out whether or not there is an accompanying sleep disorder. We suggest that pathologies that can lead to sleep problems in dysthymic patients should be searched, and to this end, application of the Epworth sleepiness scale (ESS) and polysomnography examination should be used much more frequently METHODS: We included 20 female dysthymic patients with complaints of chronic sleep problems who had been under follow-up at Uludag University Hospital Psychiatry Outpatient Clinic for at least the last two years. Twenty healthy female volunteers, aged 18-65 years, were included in the study as the control group. ESS and polysomnography examination were applied in all patients. RESULTS: When patients with DD and healthy controls were compared, significant differences in ESS scores and ratios of sleep phases were determined between groups. DD patients had higher ESS scores and higher ratios of rapid eye movements (REM), non-REM-1 (Stage 1), non-REM-2 (Stage 2) phases and lower ratios of slow wave sleep (Stage 3 + Stage 4). CONCLUSION: The findings of our study suggest that there are structural sleep changes in dysthymic patients, but no direct connection between sleep variables and depressive states is evident

Art Therapy in Patients with Psoriasis

This study aimed at investigating the themes that emerged after an art therapy and assessing the effectiveness of art therapy using psychological scales and dermatological evaluation indices before and after the therapy in individuals with psoriasis. The study included patients aged 18-65 with moderate psoriasis who had the disease for 5 or more years and were in need of systemic treatment. Those who had a concomitant physical disorder including another skin disease, an active joint disorder or a psychiatric diagnosis other than adjustment disorder were excluded from the study. A total of 15 sessions each lasting 150 minutes were held once a week. Various art techniques including music, painting, and ceramics were practiced to evaluate within the group patients’ understanding of the illness and their self-awareness. The outcomes of the study were presented over three patients who attended the sessions regularly. The dermatological evaluations, patient feedback, and observations of the psychotherapists have shown that art therapy can be an effective method in attenuating the symptoms of psoriasis and evoking awareness of repressed experiences or feelings