Kronik nöropatik ağrılı hastalarda ağrı, gün içi uykululuk, anksiyete ve depresyon düzeyleri

Objective: The current study aims to determine pain, daytime sleepiness, anxietyand depression levels of patients with chronic neuropathic pain and compare different clinical conditions causing neuropathic pain in terms of these variables. Method: 241 patients (105 patients with diabetic neuropathy, 39 patients with fibromyalgia, 27 patients with carpal tunnel syndrome, 27 patients with radiculopathy, 22 patients with trigeminal neuralgia and 21 patients with postherpetic neuralgia) were included in the study. The assessments were performed using socio-demographic data form, Visual Analog Scale (VAS), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Epworth Sleepiness Scale (ESS) and Hospital Anxiety and Depression Scale (HAD). Results: Evaluation of pain with VAS and LANSS showed no statistical difference among subgroups. Scores of LANSS and VAS were positively correlated with each other. ESS scores were found to be above the cut-off point (> 10) in all subgroups. LANSS, but not VAS scores were positively correlated with ESS scores. Depression scores were above the cut-off point (> 7) in diabetic neuropathy, fibromyalgia and trigeminal neuralgia groups and anxiety scores were above the cut-off point (> 10) in diabetic neuropathy, fibromyalgia, trigeminal neuralgia and carpal tunnel syndromegroups. No correlation was found between scores of both VAS and LANSS and scores of HADS. Depression scores correlated positively with ESS scores (r=0.153, p10) bulundu. Depresyon puanları 7 kesme noktası üzerinde ( >7) diyabetik nöropati, fibromiyalji ve trigeminal nevralji gruplarında ve anksiyete 10 kesme noktası üzerinde ( >10) diyabetik nöropati, fibromiyalji, trigeminal nevralji ve karpal tünel sendromu gruplarında yüksek bulundu. ESS ile depresyon puanları istatistiksel olarak olumlu ilişkili bulundu ( p< 0,05). Sonuçlar: Farklı nöropatik ağrılı sendromlara gündüz uykululuk, depresyon ve anksiyete eşlik edebilir. Depresyon, gün içi uykululuk ile pozitif yönde birliktelik gösterirken anksiyete ile ilişkisi gösterilememiştir.Bu sonuçlarla farklı nöropatik ağrı sendromlarında eşlik eden durumların daha iyi anlaşılması için etkisi olabilir

Effects of long-term antidepressant treatment on oxidative status in major depressive disorder: A 24-week follow-up study

Purpose: Major depressive disorder (MDD) is a devastating disease that afflicts large populations and has also been accepted to be an independent risk factor for cardiovascular disease (CVD). Oxidative stress seems to play an essential role in the relationship of MOD and CVD. We aimed to determine the level of oxidative stress in patients with MOD and to investigate the effects of long-term antidepressant (AD) treatment on the oxidative-antioxidative system parameters and CVD risk factors. Method: Fifty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MOD and 44 healthy control subjects were included in the study. Control visits of the patients were repeated 6 weeks, 12 weeks and 24 weeks after beginning of the AD treatment Lipid profiles, oxidation and oxidizability of apolipoprotein B-containing lipoproteins (expressed as apo B-b-MDA and apo B-Delta-MDA, respectively), levels of plasma malondialdehyde (p-MDA), total antioxidative capacity (TAOC), antioxidant molecules and antioxidant enzyme activities including paraoxonase/arylesterase, red blood cell superoxide dismutase (RBC-SOD) and glutathione peroxidase were determined during 24-week of follow-up period. Results: According to the results of the study, p-MDA, apo B-b-MDA and RBC-SOD activity were increased and arylesterase activity was decreased in MDD patients. Body mass index (BMI), vitamin A and total cholesterol levels in MDD patients increased after 24-weeks of AD treatment RBC-SOD activity, TAOC, p-MDA and apo B-b-MDA levels were decreased: paraoxonase/arylesterase activities and apo B-Delta-MDA were increased at the end of 24th week. Conclusion: Oxidative stress, demonstrated in MDD patients, was partly improved during 24 weeks of AD treatment Increase in paraoxonase/arylesterase activities and decrease in p-MDA and apo B-b-MDA levels after 24 weeks seem to be beneficial for reduction of CVD risk in MDD patients. However increased BMI and apo B-Delta-MDA levels are negative cardiovascular effects of long-term AD treatment

Levels of serum lipid profile, homocysteine, fibrinogen and oxidative–antioxidative system indicators in patients diagnosed with major depressive disorder and their change according to antidepressant treatment

Epidemiyolojik çalışmalar, sağlıklı ve kalp–damar hastalığı (KDH) olan bireylerde ortaya çıkan kardiyak sorunların insidansı ile majör depresif bozukluk (MDB) arasında anlamlı bir ilişki olduğunu göstermektedir. MDB hastalarında KDH riskinin, hem MDB hem de KDH gelişimine sebep olabilen, altta yatan ortak fizyolojik etkenlerin sonucunda olabileceği üzerinde durulmaktadır. Serum lipid düzeyleri, oksidatif stres, inflamasyon ve koagülasyon eğiliminde artma her iki hastalığın ortaya çıkmasıyla ilişkili görünen etkenler arasındadır. Bu çalışmada MDB ve KDH patofizyolojilerinde ortak görünen etkenlerden serum lipid profili, homosistein, fibrinojen ve oksidan–antioksidan sistem belirteçlerinin düzeyleri ve bu düzeylerin antidepresan (AD) tedaviden nasıl etkilendiğinin belirlenmesi amaçlanmıştır. Bu amaçla, MDB tanısı alan 50 hasta ile 44 sağlıklı gönüllü çalışmaya alınmıştır. İlk değerlendirmeyi takiben AD tedavi başlanarak 6., 12. ve 24. haftalarda kontrol değerlendirmeleri yapılmıştır. Çalışma sonuçlarına göre MDB ile lipid profili, homosistein ve fibrinojen düzeyleri ilişkisiz görünmektedir. MDB hastalarının oksidan–antioksidan sistem belirteçlerinde ortaya çıkan farklılıklar, MDB patofizyolojisinde ve KDH ile bağlantısında oksidatif stresin yer aldığını desteklemektedir. Uzun dönem AD tedavinin A vitamini ve yüksek yoğunluklu lipoprotein (HDL) düzeylerinde artma, bazal malondialdehid (B_MDA) ve plazma malondialdehid (pMDA) düzeylerinde azalma, paraoksonaz ve arilesteraz aktivitelerinde artma şeklinde saptanan sonuçları KDH riskini azaltıcı; vücut kitle indeksi (VKİ), kolesterol, fibrinojende artma ve total antioksidan kapasitede azalma şeklindeki sonuçları ise KDH riskini arttırıcı yöndedir. MDB hastalarının AD tedavi ve takip süreçlerinde antioksidan besinlerin tüketilmesi ve kilo alımının önlenmesiyle KDH riski azaltılabilir.The relationship between major depressive disorder (MDD) and the incidence of cardiac events in healthy and cardiovascular disease (CVD) populations is shown in a number of epidemiological studies. Increased risk of CVD in MDD patients seems to be affected by some common factors which may take role in pathophysiology of both CVD and MDD. Changes in serum lipid levels, oxidative stress, inflammation and coagulation tendency are thought to be responsible in both of these two diseases. In this study we aimed to determine serum lipid profiles, levels of homocysteine, fibrinogen and oxidative–antioxidative system indicators; and effects of antidepressant (AD) treatment on these parameters. 50 MDD patients and 44 healthy subjects were included in the study. AD treatment was started after the first evaluation. Control evaluations took place on the 6 th, 12th and 24th weeks of the follow–up period. According to results of the study, levels of serum lipids, homocysteine and fibrinogen are not related to MDD. Differences detected in the levels of oxidative–antioxidative system indicators of MDD patients in the study, support that oxidative stress takes place in the pathophysiology of MDD and suggest a relationship between MDD and CVD. Increased vitamin A and high density–lipoprotein (HDL) levels, paraoxonase and arylesterase activities; decreased basal and plasma malondialdehyde (MDA) levels after long–term AD treatment, reduce the risk for CVD. On the other hand, increased body mass index, levels of total cholesterol and fibrinogen; decreased total antioxidant capacity increase the CVD risk. In the treatment and follow–up period of MDD patients, antioxidant food intake and prevention of weight gain seem to be beneficial in order to reduce CVD risk

Myastenia gravis hastalarında psikopatoloji, psikososyal etkenler ve yaşam kalitesi

Introduction: Myasthenia Gravis (MG) is a chronic disease which affects physical, psychological and social functioning of patients. In this study we aim to determine psychiatric comorbidity, some psychosocial factors and their relations with quality of life in patients with MG. Methods: A total of 52 patients underwent psychiatric examination and the following scales were applied: Socio-demographic data form, Hospital Anxiety and Depression Scale (HADS), Quality of Life (QOL) Scale Short Form 36 (SF-36), Psychosocial Adjustment to Illness Scale-Self report (PAIS-SR), Multidimensional Scale of Perceived Social Support (MSPSS) and Posttraumatic Growth Inventory (PTGI). Results: Among 52 patients with MG, 36.5% (n=19) had no psychiatric diagnosis; 21.2% (n=11) had adjustment disorder; 19.2% (n=10) had depression and 23.1% (n=12) had anxiety disorder. Patients with a psychiatric diagnosis had lower scores in general health, vitality, social functioning, emotional role and mental health domains of SF-36. PAIS-SR scores, total MSPSS and friends scores were signifitcantly higher in patients without a psychiatric diagnosis. Significant correlaions of psychosocial factors with quality of life were determined. Conclusion: In MG patients, there is a high prevalence of psychopathology and it is associated with quality of life, perceived social support and psychosocial adjustment of the patients. Quality of life is reduced in both physical and mental aspects. Diagnosis and treatment of psychopathology in MG patients is crucial to decrease disease burden.Giriş: Myastenia Gravis (MG), hastaların fiziksel, psikolojik ve sosyal fonksiyonlarını etkileyen kronik bir hastalıktır. Bu çalışmada MG hastalarında psikiyatrik komorbidite, bazı psikososyal etkenleri ve bunların hastaların yaşam kalitesiyle ilişkisini saptamayı amaçladık. Metodlar: Toplam 52 MG hastasına psikiyatrik muayene yapıldı ve sosyodemografik veri formu, Hastane Anksiyete ve Depresyon Ölçeği, SF-36 Yaşam Kalitesi Ölçeği,Kısa Formu, Hastalığa Psikososyal Uyum Özbildirim Ölçeği, Çok-boyutlu Algılanan Sosyal Destek Ölçeği ve Travma Sonrası Büyüme Envanteri uygulandı Bulgular: Hastaların % 36.5 (n=19)'u herhangi bir psikiyatrik tanı almazken; %21.2 (n=11)'si uyum bozukluğu, %19.2 (n=10)'si depresyon ve %23.1 (n=12)'i anksiyete bozukluğu tanısı aldı. Psikiyatrik tanı alan hastalar SF-36 Yaşam Kalitesi Ölçeği'nin genel sağlık, canlılık, sosyal fonksiyon, duygusal rol ve ruhsal sağlık alanlarında daha düşük puan aldılar. Hastalığa psikososyal uyum, toplam algılanan sosyal destek ve arkadaş desteği puanları, psikiyatrik tanı almayan hastalarda daha yüksekti. Psikososyal etkenler ve yaşam kalitesi arasında anlamlı ilişkiler saptandı. Sonuç: MG hastalarında oldukça sık görülen psikiyatrik sorunlar hastaların yaşam kalitesi, algılanan sosyal destek ve psikososyal uyumlarıyla ilişkilidir. Yaşam kaliteleri hem fiziksel hem de ruhsal alanlarda azalmıştır. MG hastalarında psikopatolojinin tanınması ve tedavisi hastalık yükünün azaltılmasında elzemdir

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

The severity of dissociative symptoms among patients with cannabis and synthetic cannabinoid use disorder: association with substance use characteristics and suicide

Background: Chanarin Dorfman Syndrome (CDS) is a rare autosomal recessive disorder characterized by the multisytemic accumulation of neutral lipids inside the cytoplasmic lipid droplets. This condition is caused by mutations in the abhydrolase domain containing 5 gene (ABHD5). In CDS the skin involvement is the prevalent and always observed clinical feature, consisting of a non-bullous congenital ichthyosiform erythroderma (NCIE). Moreover, a variable involvement of the liver and neuromuscular system can be also observed. In this report, we aimed to perform the clinical and genetic characterization of a patient affected by CDS with atypical dermatological findings, considering this rare inborn error of neutral lipid metabolism. Methods: Genomic DNA samples obtained from patient and his parents were used to perform the sequencing of the ABHD5 exons and their intron/exon boundaries. Bioinformatic analyses were performed to investigate the possible effect of the identified mutation on protein structure. Results: Here we present the case of a 29-year-old male patient with CDS, who, for long time, has been misdiagnosed as pityriasis rubra pilaris (PRP). He has a history of increasing hyperlipidemia; hepatomegaly associated with hepatosteatosis was also detected. ABHD5 molecular analysis revealed a novel missense mutation, the c.811G > A (p.G271R). Bioinformatic investigations showed that the variant has a deleterious effect on ABHD5 function, probably causing an incorrect folding of the mutant protein. Conclusions: These results highlihts the importance of genetic testing for ABHD5 in unresolved cases of patients presenting unusual skin lesions, that resemble PRP, associated with a history of hyperlipidemia and nonalcoholic fatty liver

Kannabis ve sentetik kannabinoid kullanan erkeklerde sosyodemografik özellikler, klinik özellikler ve serum karaciğer işlev testleri

Objective: Synthetic cannabinoid (SC) use has recently become a growing substance abuse problem, with serious harmful clinical effects. Young males, especially cannabis (C) users, are at great risk of SC use. The aim of this study is to determine sociodemographic characteristics, clinical features and serum liver function tests of SC users and compare with those of C users. Methods: Out of 118 SC users applied to outpatient clinic of Ankara Numune Training and Research Hospital Alcohol and Substance Addiction Treatment Center, 74 males included in this cross-sectional study. Patients with a concurrent use of any medication or substance other than C/SCs or patients with any physical illness which could affect serum liver function tests were excluded. 44.6% (n=33) of 74 patients were only SC users at least for last three months and 55.4% (n=41) were combined C and SC (C&SC) users. SC users were compared with 34 age and BMI-matched only C using males. Results: Rates of being single and divorced; rates of living with friends and alone were found to be higher in SC users. Adverse effects and withdrawal sypmtoms were found to be similar in C users and SC users. According to serum liver function test results, levels of gama-glutamil transpeptidase, alkaline phosphatase, total/direct bilirubin, albumin, prothrombin time and international normalized ratio were similar. Serum aspartate aminotransferase levels (31.2±22.0 IU/L and 41.5±21.5 IU/L respectively, p=0.026) and serum alanine aminotransferase levels (28.4±18.9 IU/L and 44.3±25.9 IU/L respectively, p=0.015) differed between C users and C&SC users. Results in this study revealed that increased serum levels of aminotransferases were especially associated with combined use of C and SCs. Conclusions: C abuse seems to be a precursor of SCs abuse, and risk of starting SCs use could be bigger for C users, who live alone or with friends, whereas living together with a family could be preventative. Combined use of C and SCs seem to increase the risk of hepatocellular injury compared to either C or SCs alone.Amaç: Sentetik kannabinoidler (SK), ciddi zararlı klinik etkileriyle, önemli bir madde kullanım sorunu haline gelmiştir. Özellikle kannabis (K) kullanan genç erkekler, SK kullanma riskine sahiptir. Bu çalışmanın amacı SK kullanıcılarının sosyodemografik özellikleri, klinik özellikleri ve serum karaciğer işlev testlerinin araştırılması ve bu verilerin K kullanıcılarınınkilerle karşılaştırılmasıdır. Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi AMATEM Polikliniği’nde değerlendirilen 118 SK kullanıcısı arasından 74 erkek hastanın katıldığı kesitsel bir çalışmadır. K ve SK dışında madde veya ilaç kullanımı olan ve serum karaciğer işlev testlerini etkileyebilecek herhangi bir fiziksel hastalığı olan hastalar çalışma dışı tutulmuştur. Yetmiş dört hastanın %44.6’sı (s=33) son üç aydır yalnız SK kullanmaktayken, %55.4’ü (s=41) K ve SK aynı anda kullanmaktaydı. Kontrol grubunu yaş ve beden kitle indeksi açısından eşleştirilmiş 34 yalnız K kullanıcısı erkek oluşturdu. Bulgular: K kullanıcılarında eş-çocukla, anne-babayla birlikte yaşama oranı SK kullanıcılarından daha yüksek, SK kullanıcılarında ise arkadaşlarıyla yaşama ve yalnız yaşama oranı K kullanıcılarından daha yüksek saptandı. Advers etkiler ve kesilme belirtileri K ve SK kullanıcılarında benzerdi. Serum karaciğer işlev testleri karşılaştırıldığında gama-glutamil transpeptidaz, alkalin fosfataz, total/ direkt bilirubin, albumin, protrombin zamanı ve INR (International Normalized Ratio) düzeyleri benzerdi. Kannabis kullanıcıları ile K ve SK kullanıcıları arasında serum aspartat aminotransferaz düzeyleri (sırasıyla 31.2±22.0 IU/L ve 41.5±21.5 IU/L, p=0.026) ve serum alanin aminotransferaz düzeyleri (sırasıyla 28.4±18.9 IU/L and 44.3±25.9 IU/L, p=0.015) anlamlı olarak farklı saptandı. Çalışmamızın sonuçları serum aminotransferaz düzeylerindeki artışın özellikle kombine K ile SK kullanıcılarında olduğunu gösterdi. Sonuçlar: K kullanımı SK kullanımı için bir öncü olabilir ve arkadaşlarıyla veya yalnız yaşayan K kullanıcıları için SK kullanımı riski daha fazlayken, aileyle yaşama koruyucu bir etken olabilir. K ev SK kombine kullanımının hepatoselüler hasara yol açma riski, K veya SK tek başına kullanımından daha yüksek görünmektedir

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