Hyperprolactinemia with aripiprazole: A case report and review of the literature

Hyperprolactinemia is an important but often a neglected side effect of antipsychotic treatment. Aripiprazole is one of the new atypical antipsychotics that has partial agonist effects on dopamine D2 receptors and has a low possibility of hyperprolactinemia. In the present case report, we discuss a female patient who was diagnosed as suffering from depression with psychotic symptoms. Her prolactin levels were elevated while on treatment with aripiprazole. Clinicians should consider that aripiprazole may result in moderate elevation of prolactin levels although it is reported that it has a lower risk of elevation of prolactin levels. © 2014, Cukurova Univ Tip Fakultesi Psikiyatri Anabilim Dali. All rights reserved

Practice of Acute and Maintenance Electroconvulsive Therapy in the Psychiatric Clinic of a University Hospital from Turkey: Between 2007 and 2013

Objective: Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years' observation with acute and maintenance ECT in a university hospital in Turkey. Methods: The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results: A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion: The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs. Copyright © 2016, Korean College of Neuropsychopharmacology

Association of SNAP-25 gene Ddel and Mnll Polymorphisms with adult attention deficit hyperactivity disorder

Objective The synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters. Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD). We investigated whether these SNAP-25 polymorphisms (MnlI T/G and DdelI T/C) were also associated with ADHD in the Turkish population. Methods: Our study comprised unrelated 139 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. Results: SNAP-25 DdelI polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 MnlI polymorphism. For SNAP-25 MnlI polymorphism patients with G/G genotype of the SNAP-25 gene MnlI polymorphism had higher Wender-Utah scores and higher scores in the 1st and 3rd parts of adult ADD/ADHD Scale. Conclusion: We detected a significant association of the MnlI polymorphism in our ADHD sample which was similar to previous findings. Our study also revealed that SNAP-25 MnlI polymorphism was also associated with symptom severity of ADHD. This study is also, the first report on the association of SNAP-25 with ADHD in the Turkish population. © 2014 Korean Neuropsychiatric Association

Association of the synaptobrevin-2 (VAMP2), synapsin III and syntaxin 1A genes with adult attention deficit hyperactivity disorder and the effects of these genes on the neuropsychological functions

Dikkat eksikliği hiperaktivite bozukluğu çocukluk döneminde başlayan ve temel belirtileri dikkatsizlik, aşırı hareketlilik ve dürtüsellik olan bir bozukluktur. DEHB'nin etiyolojisi henüz tam olarak aydınlatılamamıştır. Etiyolojide özellikle gen?çevre etkileşiminin ve prefrontal striatal serebellar dizgenin yapısal ve metabolik farklılığının rol oynadığı düşünülmektedir. Genetik araştırmalar daha çok dopaminerjik yolaklar ve dopamin reseptörleri üzerinedir. Bu çalışmada, erişkin DEHB ile presinaptik proteinleri kodlayan genlerden olan sinaptobrevin-2 (VAMP2), sinapsin III ve sintaksin 1A genlerinin ilişkisi ve bu genlerin nöropsikolojik test performansları üzerine etkisinin araştırılması hedeflenmiştir. Çalışmaya DEHB tanısı almış olan 18-60 yaş arası 139 olgu ve 106 sağlıklı kontrol alındı. Katılımcılardan kan örneği alınarak genetik analizler yapıldı. Her iki gruba Nörolojik Değerlendirme Ölçeği ve nöropsikolojik testler (Sayı dizleri, sözel bellek, stroop ve Wisconsin kart eşleme testi) uygulandı. DEHB ile VAMP2 geni İns/Del polimorfizmi, sinapsin III geni -631 C>G polimorfizmi ve sintaksin 1A geni intron 7 polimorfizmi arasında kontrol grubuna göre anlamlı bir ilişki bulundu. DEHB ile sinapsin III geni -196 G>A polimorfizmi arasında ise anlamlı bir ilişki bulunmadı. Erişkin DEHB grubunda sayı dizileri, sözel bellek ve stroop testlerinde kontrol grubuna göre anlamlı düzeyde düşük performans saptandı. WKET'de erişkin DEHB grubu ile kontrol grubu arasında farklılık bulunmadı. Erişkin DEHB grubunda silik nörolojik belirtilerde kontrol grubuna göre düşük performans saptandı. VAMP2 geni İns/Del polimorfizmi İns/İns genotipi sayı dizileri ve sözel bellek testlerinde kötü performans, stroop testinde daha iyi performans ile ilişkili bulundu. Sinapsin III geni -196 G>A polimorfizmi G/G genotipi sayı dizileri testinde düşük performans, sinapsin III geni -631 C>G polimorfizmi C/G genotipi sayı dizileri ve stroop testlerinde daha iyi performans ile ilişkili bulundu. Sintaksin 1A intron 7 polimorfizmi T/T genotipi sayı dizileri testinde daha iyi performans ile ilişkili bulundu. WKET performansı ile herhangi bir gen arasında ilişki bulunmadı. DEHB'nin etiyolojisinde dopamin genlerinin yanı sıra sinaptik protein genlerinin de rol aldığı, parietal korteks ve frontostriatal yolaklarda işlev bozukluğu olduğu düşünüldü. Riskli genler ile nöropsikolojik bulguların paralellik göstermediği düşünüldü.Attention deficit hyperactivity disorder (ADHD) is a disorder that begins in childhood and has main symptoms of inattention, overactivity and impulsivity. The etiology of ADHD has not been entirely clarified yet. Structural and metabolic differences at the prefrontal striatal cerebellary system and the interaction of gene and environment are the main factors thought to play a role in the etiology. Genetic investigations are performed especially about the dopamine pathways and receptors. In this study; it was aimed to investigate the association of the synaptobrevin-2 (VAMP2), synapsin III and syntaxin 1A genes, which take place in encoding presynaptic proteins, with adult attention deficit hyperactivity disorder and the effects of these genes on the neuropsychological test performances. One hundred thirty-nine patients, having ADHD aging between 18 and 60 years and 106 healthy people as controls were included into the study. Blood samples were taken from the participants and genetic analysis were performed. Neurological Grading Scale and neuropsychological tests (Digit span, verbal memory, stroop test and Wisconsin Card Sorting Test (WCST)) were performed to both groups. A significant difference was determined between ADHD and VAMP2Ins/Del polymorphism, synapsin III-631 C>G polymorphism and syntaxin 1A intron 7 polymorphism according to the control group. No significant difference was determined between ADHD and synapsin III-196 G>A polymorphism. Significantly low performance was determined on the digit span, verbal memory and stroop tests in the adult ADHD group according to the control group. No significant difference was determined between the adult ADHD group and the control group on the WCST. Low performance was determined at the neurological soft signs in the adult ADHD group according to the control group. While Ins/Ins genotype of VAMP2 Ins/Del polymorphism was found to be related to worse performance on the digit span and verbal memory tests, it was found to be related to better performance on stroop test. G/G genotype of synapsin III-196 G>A polymorphism was found to be associated with worse performance on the digit span test. C/G genotype of synapsin III-631 C>G polymorphism was found to be associated with better performance on the digit span and stroop tests. T/T genotype of syntaxin 1A intron 7 polymorphism was found to be associated with better performance on the digit span test. No association was found between WSCT performance and any genes. It is believed that dopaminergic genes together with synaptic protein genes might have roles in the etiology of ADHD and functional defects at the parietal cortex and frontostriatal pathways might interfere in this disorder. It was also believed that risky genes do not show any parallelism with neuropsychological signs

Effects of methylphenidate treatment on the cerebellum in adult attention-deficit hyperactivity disorder: a magnetic resonance spectroscopy study

OBJECTIVE: This study investigated the relationship between the use of methylphenidate (MPH) and changes in creatine, choline, and N-acetyl-aspartate (NAA) in the dorsolateral prefrontal cortex (DLPFC), striatum, cerebellum, and anterior cingulate cortex (ACC) in adults with attention-deficit hyperactivity disorder (ADHD).PATIENTS AND METHODS: The study enrolled 60 patients 18-60 years of age who met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for ADHD. The amounts of NAA, creatine, and choline in the ACC, cerebellum, striatum, and DLPFC were measured using magnetic resonance spectroscopy. After the first measurement, the patients were given 10 mg oral MPH, and the same metabolite levels were measured 30 minutes later.RESULTS: No significant differences were observed in the NAA and choline levels in the DLPFC, ACC, cerebellum, and striatum after MPH. Although there were no significant differences in the creatine levels in the DLPFC, ACC, and striatum after MPH, the creatine level in the cerebellum increased significantly.CONCLUSIONS: Our results suggest that MPH affects the cerebellum in adult ADHD. Therefore, we suggest that, due to its effects on the cerebellum, MPH can be used in adult ADHD not only for attention deficit symptoms but also for hyperactivity symptoms

Relationship between the SNAP-25 gene and the effects of methylphenidate on the anterior cingulate cortex of patients with adult attention deficit hyperactivity disorder: A magnetic resonance spectroscopy study

Objective: The effects of certain genetic alterations in the brain function of patients with attention deficit hyperactivity disorder (ADHD) remain unclear and, in fact, there is a limited amount of data in this field. For example, the relationship between the SNAP-25 polymorphism and brain metabolites in response to methylphenidate (MPH) has yet to be investigated. Thus, the present study aimed to determine the relationship between changes in creatine (Cr), choline (Cho), and N-acetyl aspartate (NAA) levels in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) of adults with ADHD and the SNAP-25 gene polymorphism following the use of MPH. Patients and Methods: The present study assessed 60 patients between 18 and 60 years of age who were diagnosed with ADHD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Genetic analyses were carried out using blood samples obtained from the ADHD patients and included a detailed clinical evaluation for the SNAP-25 gene polymorphism. The NAA, Cr, and Cho levels in the ACC and PFC were measured using magnetic resonance spectroscopy (MRS). Following the evaluation, 10 mg of oral MPH was given to the patients, and the same metabolite levels were measured after 30 minutes. Results: The levels of NAA, Cr, and Cho in the PFC and ACC of patients with the SNAP-25 Ddel and Mnll polymorphism genotypes did not significantly differ before and after the administration of MPH. However, in patients with the SNAP-25 Ddel polymorphism T/T genotype and the Mnll polymorphism G/G genotype, there was a significant increase in NAA levels in the ACC after MPH treatment compared with before MPH treatment. Conclusion: The present results suggest that the SNAP-25 Ddel and Mnll polymorphisms might be associated with MPH-related changes in NAA levels in the ACC

Relationship between the DAT1 gene and the effects of methylphenidate administration in adult attention deficit hyperactivity disorder: A magnetic resonance spectroscopy study

OBJECTIVE: This study investigated the relationship between DAT1 gene polymorphisms and the effects of methylphenidate (MPH) administration on N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho) levels in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum in adult patients with attention deficit hyperactivity disorder (ADHD). This was the first study to investigate the relationship between DAT gene variable number tandem repeat (VNTR) polymorphisms and the responses of brain metabolites to MPH. PATIENTS AND METHODS: Samples in this study were collected from 60 patients aged between 18 and 60 years with ADHD according to DSM-IV criteria. Genetic analysis of DAT1 gene polymorphisms was carried out using blood samples obtained after a detailed clinical evaluation. Levels of NAA, Cr, and Cho were measured in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum by magnetic resonance spectroscopy. After this evaluation, 10 mg of MPH was given orally to patients, and the levels of the same metabolites were measured 30 min later. RESULTS: No marked difference in NAA, Cr, or Cho levels was detected before and after MPH administration with respect to the DAT1 gene VNTR polymorphisms. A considerable increase in Cr levels in the cerebellum was identified after MPH administration in individuals with the 10/10 repeat genotype as the DAT1 VNTR polymorphism (p=0.008). CONCLUSIONS: An increase in the previously decreased blood flow after MPH therapy may induce an increase in creatine levels in patients with the 10/10 repeat genotype. Our results thus suggest that the 10R allele as the DAT1 gene VNTR polymorphism might be associated with MPH-related changes in brain metabolites in adults with ADHD