Celal Bayar University
Psychiatry
Background: Immunologic mechanisms may be responsible for the development and maintenance of schizophrenia symptoms. Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor necrosis factor-alpha... more
Background: Immunologic mechanisms may be responsible for the development and
maintenance of schizophrenia symptoms.
Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor
necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor
II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine
their relationship with the symptoms of schizophrenia.
Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and
Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35),
and the results were compared with healthy controls (n = 30). Hierarchical regression analyses
were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII.
Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-
αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII
levels were found to be negatively correlated with the negative subscale score of the PANSS,
and sTNF-αRI levels were also negatively correlated with the total score of the PANSS.
Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor
levels.
Conclusions: These results suggest that there may be a change in antiinflammatory response
in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also
supports low levels of TNF activity in schizophrenia patients with negative symptoms.
maintenance of schizophrenia symptoms.
Aim: The aim of this study is to measure tumor necrosis factor-alpha (TNF-α), soluble tumor
necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumor necrosis factor-alpha receptor
II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine
their relationship with the symptoms of schizophrenia.
Methods: Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. Positive and
Negative Syndrome Scale (PANSS) was administered in patients with schizophrenia (n = 35),
and the results were compared with healthy controls (n = 30). Hierarchical regression analyses
were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII.
Results: No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-
αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII
levels were found to be negatively correlated with the negative subscale score of the PANSS,
and sTNF-αRI levels were also negatively correlated with the total score of the PANSS.
Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor
levels.
Conclusions: These results suggest that there may be a change in antiinflammatory response
in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also
supports low levels of TNF activity in schizophrenia patients with negative symptoms.
- by Sedat Batmaz and +2
- •
- Psychiatry, Immunology, Psychosis, Schizophrenia
Objective: The goal of the study was to determine the level of information of the doctors on Consultation-Liaison Psychiatry (CLP) and psycho-oncology (PO) at the beginning of settling of a psychiatry clinic and two years later. Method:... more
Objective: The goal of the study was to determine the level of information of the doctors on Consultation-Liaison Psychiatry (CLP) and psycho-oncology (PO) at the beginning of settling of a psychiatry clinic and two years later. Method: Two hundred and seventeen doctors working in the hospital were applied a questionnaire, which was prepared by us for obtaining information about the doctor's opinions on CLP and PO. The questionnaire was reapplied in the same way two years after. Doctors answered the questionnaire by choosing one of four options: "high", "moderate", "low", "any". Results: On first application, the rate of answering the questionnaire was 48.3%; after two years, the rate was higher than previous application (68.2%). The level of information on CLP and PO of the doctors increased in two years time (p=0.001). Doctors answered positively that psychiatrist have to be included in oncology team on the first application 50%, two years after 78%, (p=0.0001). The frequency of pscychiatric consultation ratios were 16% "high", 33% "moderate", 37% "low" ve 14% "any "after two years ratios were 25 % "high", 49% moderate,22% "low", 4% "any" (p=0.002). Conclusion: According to the results of questionnaire; doctors working in our hospital have been much more informed on CLP and PO in two years time, interested in much more about their patients' psychiatric complaints and they have frequently consultated their patients and especially explained that psychiatrists have to be included in oncology team.
- by levent turhan and +1
- •
Majör depresif bozukluğun akut dönem tedavisinde sitalopram ve essitalopram'ın yaşam kalitesi üzerine etkisi: Karşılaştırmalı açık bir çalışma Amaç: Major depresif bozuklukta tedavi ile belirtilerde düzelme elde edilirken, hastaların... more
Majör depresif bozukluğun akut dönem tedavisinde sitalopram ve essitalopram'ın yaşam kalitesi üzerine etkisi: Karşılaştırmalı açık bir çalışma Amaç: Major depresif bozuklukta tedavi ile belirtilerde düzelme elde edilirken, hastaların işlevselliklerinin ve öznel yaşam kalitelerinin de geliştirilmesi hedeflenmektedir. Bu çalışmada major depresif bozukluk tanısı konmuş hastalarda sitalopram ve essitalopram tedavilerinin karşılaştırmalı olarak yaşam kalitesi üzerine etkisini değerlendirmek ve ayrıca tedavi sonucunda düzelen hastalarda normal toplum değerleri ile karşılaştırmak amaçlanmıştır. Yöntem: Çalışma psikiyatri polikliniğine başvuran ve major depresif bozukluk tanısı konan 74 hasta ile yürütülmüştür. Sitalopram grubunda hastaların yaş ortalaması 40.6 olarak bulunmuştur ve 24'ü (%63.5) kadındır. Essitalopram grubunda ise hastaların yaş ortalaması 38.6 olarak elde edilmiştir ve kadın oranı %62.2 olarak saptanmıştır. Hastalık süresi sitalopram grubunda 3.19 yıl, essitalopram grubunda 3.49 yıldır. Sitalopram grubunda hastaların %54.1'inde tek dönem varken, bu oran essitalopram grubunda %81.1 olarak gözlenmiştir. Hastaların depresyon şiddeti Hamilton Depresyonu Derecelendirme Ölçeği (HAM-D) ile belirlenmiş, yaşam kalitesinin incelenmesi amacıyla Kısa Form-36 (SF-36) ve EuroQol-5D (EQ-5D) ölçekleri uygulanmıştır. Tedavide randomize olarak grubun yarısına sitalopram ve diğer yarısına essitalopram uygulanmıştır ve hastalar 2., 4. ve 6. haftalarda değerlendirilmiştir. Tedavide başlangıç dozu sitalopram için 20 mg/ gün, essitalopram için 10 mg/gün olarak belirlenmiştir. Tedaviye yanıt olarak HAM-D ile değerlendirilen depresyon şiddetinde başlangıç puanına göre %50 azalma ve düzelme olarak ise HAM-D≤7 kabul edilmiştir. İkinci haftadan itibaren HAM-D puanı %25 oranında azalma göstermeyen hastalarda tedavi ilacının dozu %50 arttırılmıştır. İstatistiksel değerlendirmede normal dağılıma uyan grupta T Testi, normal dağılım göstermeyen grupta ise Mann-Whitney U Testi uygulanmıştır. Ayrıca sağlanan düzelmede etki büyüklüğünü göstermek amacıyla Cohen d etki büyüklüğü hesaplanmıştır. Bulgular: Hastaların altı hafta sonunda kullandıkları ortalama ilaç dozları sitalopram için 24.6 mg/gün ve essitalopram için 11.8 mg/ gün olarak elde edilmiştir. Tüm hastalar tedaviye yanıt vermiş olup remisyon oranı (HAM-D≤7) %63.5'tur. Yanıt veren ve remisyona ulaşan hasta oranları açısından sitalopram ve essitalopram grupları arasında istatistiksel farklılık saptanmamıştır. Yaşam kalitesi ölçümlerinde, SF-36 ve EQ-5D ölçeklerinin tüm alt ölçeklerinde dördüncü haftadan itibaren istatistiksel olarak anlamlı düzelme gözlenmiştir. Her iki ilaç grubu karşılaştırıldığında yaşam kalitesi değişkenleri açısından herhangi bir farklılık saptanmamıştır, ancak ikinci haftada essitalopram grubunda daha fazla sayıda yaşam kalitesi değişkeninde düzelme elde edilmiştir. Her ne kadar altıncı haftanın sonunda hastalarda istatistiksel olarak anlamlı düzelme elde edilmiş olsa bile, bu düzelmenin etki büyüklüğü orta düzeydedir. Her iki ilaç grubundan remisyona giren hastalarda (n=53) toplum standart değerleriyle karşılaştırıldığında, SF-36 ölçeğinin fiziksel rol güçlüğü, genel sağlık algısı, sosyal işlevsellik ve emosyonel rol güçlüğü alt ölçekleri anlamlı olarak düşüktür. Tedavinin sonunda yineleyici depresyonu olan hastalarda yaşam kalitesi yönünden daha fazla bozulma saptanmıştır. Sonuç: Hastalarda akut dönem tedavisinde sitalopram ile essitalopram arasında yaşam kalitesinde düzelme yönünden anlamlı farklılık yoktur. Yaşam kalitesi ve psikososyal işlevsellik açısından ölçek puanlarında düşme elde edilmekte ancak normal düzeye dönme sağlanamamaktadır. Anahtar sözcükler: Major depresif bozukluk, yaşam kalitesi, remisyon, sitalopram, essitalopram Kli nik Psikofarmakoloji Bülteni 2011;21(3):210-8 ABS TRACT: Effect of citalopram versus escitalopram on quality of life in the treatment of the acute phase of major depressive disorder: a comparative, open-label study
- by haldun soygur
- •
Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients... more
Background: There are very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim 11 of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of 12 Beck's cognitive theory.
Amaç: Major depresif bozukluk işlevsellik ve yaşam kalitesinde en fazla bozulma yaratan hastalıkların başında gelmektedir. Bu araştırmada major depresif bozukluk tanısı konan hastalarda yaşam kalitesinin ve depresyon ile ilişkisinin... more
Amaç: Major depresif bozukluk işlevsellik ve yaşam kalitesinde en fazla bozulma yaratan hastalıkların başında gelmektedir. Bu araştırmada major depresif bozukluk tanısı konan hastalarda yaşam kalitesinin ve depresyon ile ilişkisinin ortaya konması amaçlanmıştır. Yöntem: Bu araştırma major depresif bozukluk tanısı konmuş 74 hasta ile yürütülmüştür. Hastaların depresyon şiddeti Hamilton Depresyonu Derecelendirme Ölçeği (HAM-D) ile belirlenmiş, yaşam kalitesinin incelenmesi amacıyla Kısa Form-36 (SF-36) ve EuroQol-5D (EQ-5D) ölçekler uygulanmıştır.
It is well estabhished that the frequency of all types of personality disorders are increased in schizophrenia. Stable personality traits influence the progress of the illness. The aim of this study was to investigate comorbid personality... more
It is well estabhished that the frequency of all types of personality disorders are increased in schizophrenia. Stable personality traits influence the progress of the illness. The aim of this study was to investigate comorbid personality disorders and their relations with positive and negative symptoms in schizophrenia patients.
An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major... more
An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major depression exhibit plasma interleukin-6 abnormalities and dexamethasone suppression test results. Four groups, each consisting of 30 women (1--healthy women, 2--patients with major depression, 3--breast cancer patients without major depression, 4--breast cancer patients with major depression), were compared to each other. Psychiatric evaluations were made by structured clinical interview for DSM-IV. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. A dexamethasone suppression test was applied. Breast cancer patients with major depression had markedly higher plasma levels of interleukin-6 than the other group. All breast cancer patients with depression had abnormal dexamethasone suppression test results. These findings suggest a hypothalamo-pituitary-adrenal axis activation and plasma levels of interleukin-6 and plasma interleukin-6 elevation and plasma levels if interleukin-6 and plasma levels of post cortisol concentrations. Evidence for a casual link or association of major depression with immune and endocrinological activation needs to be investigated further.
It is not scarce that patients experience various extrapyramidal symptoms (EPS) during antidepressant drug therapy. Thus, choice of an antidepressant drug in case of extrapyramidal side effects, at present, is a dilemma. Escitalopram,... more
It is not scarce that patients experience various extrapyramidal symptoms (EPS) during antidepressant drug therapy. Thus, choice of an antidepressant drug in case of extrapyramidal side effects, at present, is a dilemma. Escitalopram, which is a recently marketed selective serotonin reuptake inhibitors (SSRI), has no such reputation. There is just one case reported for tianeptine that induced abnormal involuntary movements/extrapyramidal side effects. We would like to present a case that was successfully managed with bupropion which had developed EPS during 2 different SSRI (sertraline and escitalopram) and tianeptine therapy.
- by haldun soygur and +2
- •
- Case Report, Mental Disorders, SERTRALINE, Drug Therapy
The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for... more
The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for identifying clinically significant distress. One hundred and eighty two cancer patients completed the DT, Problem List (PL), and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). The receiver operating characteristic (ROC) curve analyses of DT scores yielded an estimated area under the curve of 0.66 when compared to the HADS cut-off score, suggesting the DT is an effective scale to discriminate between classified cancer patients both with and without clinically significant distress. The DT cut-off score of 4 yielded the optimal combination of sensitivity and specificity. Scores on the DT were moderately correlated to the HADS (p50.01) and EORTC QLQ-C30. Based on the significant correlations, we conclude that the DT has acceptable criterion validity.
Objective: Adjustment disorders (ADs) and major depressive disorder (MDD) are often the most prevalent psychiatric disorders among cancer patients. This study's objective was to determine the overall performance of Hospital Anxiety and... more
Objective: Adjustment disorders (ADs) and major depressive disorder (MDD) are often the most prevalent psychiatric disorders among cancer patients. This study's objective was to determine the overall performance of Hospital Anxiety and Depression Scale (HADS) as a screening instrument in identifying cases of psychiatric morbidity such as ADs and MDD.
Goals of the work This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also... more
Goals of the work This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms. Materials and methods Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit. Main results There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p=0.001, p= 0.001, p=0.003). There were also significant differences in the mean total (p=0.03), anxiety (p=0.003), and depression (p=0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients. Conclusion Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.
Kabul tarihi / Date of acceptance: 15 Austos 2008 / August 15, 2008 ÖZET: Aripiprazol'ün farmakodinamik ve farmakokinetik özel- likleri Birinci kuflak antipsikotik ilaçlar›n klinik kullan›ma girmelerinden bu yana geçen elli y›l›... more
Kabul tarihi / Date of acceptance: 15 Austos 2008 / August 15, 2008 ÖZET: Aripiprazol'ün farmakodinamik ve farmakokinetik özel- likleri Birinci kuflak antipsikotik ilaçlar›n klinik kullan›ma girmelerinden bu yana geçen elli y›l› aflk›n süre içinde, farkl› etki mekanizmalar› üzerin- den etki gösteren yeni antipsikotik ilaçlar›n bulunabilmesi için büyük bir çaba harcanm›flt›r. Atipik antipsikotikler içinde, dopamin D2 resep- törleri üzerinde k›smi
The purpose of this study was to develop and validate the Sexual Adjustment and Body Image Scale (SABIS), a self-report measure of body image and sexual adjustment for use with Turkish patients with breast cancer. We administered the... more
The purpose of this study was to develop and validate the Sexual Adjustment and Body Image Scale (SABIS), a self-report measure of body image and sexual adjustment for use with Turkish patients with breast cancer. We administered the SABIS to one hundred sixty-nine women who had undergone initial surgical treatment for primary breast cancer. The psychometric properties of the SABIS were examined, and it was found to be a reliable and valid assessment of body image and sexuality in patients with breast cancer following surgery; however, it did not cover all dimensions representing patients' sexuality and body image. Patients' sexual problems need to be assessed more comprehensively, using more culturally sensitive items.
To investigate quality of life and its association with depression in patients with major depressive disorder. The study included 74 patients diagnosed with major depressive disorder according to DSM-IV. The Hamilton Depression Rating... more
To investigate quality of life and its association with depression in patients with major depressive disorder. The study included 74 patients diagnosed with major depressive disorder according to DSM-IV. The Hamilton Depression Rating Scale (HAM-D) was used to assess the severity of depression; and the, Medical Outcomes Study Short Form-36 (MOS SF-36) and EuroQol 5-D (EQ-5D) were used to measure quality of life. In the assessment of quality of life, it was determined that Patients with major depressive disorder scored significantly lower on all domains of MOS SF-36 compared to Turkish normative data. The depressive disorder patients had lower EQ-5D health utility index scores, in comparison to Turkish normative data. There was a significant negative correlation between mean HAM-D score and all domains of MOS SF-36 and EQ-5D health utility index scores. When quality of life in depressive patients was compared according to episode type, patients with recurrent type major depressive di...
The purpose of this study was to develop and validate the Sexual Adjustment and Body Image Scale (SABIS), a self-report measure of body image and sexual adjustment for use with Turkish patients with breast cancer. We administered the... more
The purpose of this study was to develop and validate the Sexual Adjustment and Body Image Scale (SABIS), a self-report measure of body image and sexual adjustment for use with Turkish patients with breast cancer. We administered the SABIS to one hundred sixty-nine women who had undergone initial surgical treatment for primary breast cancer. The psychometric properties of the SABIS were examined, and it was found to be a reliable and valid assessment of body image and sexuality in patients with breast cancer following surgery; however, it did not cover all dimensions representing patients' sexuality and body image. Patients' sexual problems need to be assessed more comprehensively, using more culturally sensitive items.
This study aimed to compare the clinical and social benefits associated with Optimal Case Management (OCM) treatment that employ cognitive-behavioural strategies to those associated with Routine Case Management (RCM) that is widely used... more
This study aimed to compare the clinical and social benefits associated with Optimal Case Management (OCM) treatment that employ cognitive-behavioural strategies to those associated with Routine Case Management (RCM) that is widely used in community health services. Hundred patients with schizophrenia were randomly allocated to OCM and RCM treatment conditions. Patients in the OCM condition showed significantly more improvement on all measures compared to patients in RCM condition. Improvement on clinical symptoms and social functioning achieved by OCM tended to show a regular and continuous pattern throughout the course of the study. The results of this study suggest that every optimal treatment should aim improvement in social functioning and therefore quality of life of the patients.
Introduction: The aim of this study is to adapt the Multidimensional Observation Scale for Elderly Subjects developed by Helmes, Csapo and Short (1987) to Turkish for the aged care workers. The Multidimensional Observation Scale for... more
Introduction: The aim of this study is to adapt the Multidimensional Observation Scale for Elderly Subjects developed by Helmes, Csapo and Short (1987) to Turkish for the aged care workers. The Multidimensional Observation Scale for Elderly Subjects was developed in order to assess the psycho-social functioning of older adults. Methods: The scale has five functional domains, each consisting of eight items. There are a total of 40 items in the scale. The scale was applied to 229 older adults by two social workers who are studying in the field. There were 119 older adults who volunteered to participate in the study among 233 older adults staying in Karabük Yücel Nursing Home and Kastamonu Nursing and Rehabilitation Center and 110 older adults living with their families in Kastamonu. Results: The Cronbach Alpha values of the functional domains of the scale were found to be .89 for self-care; .85 for disorientation; .80 for depression/anxiety; .77 for irritability, and .87 for withdrawal, respectively. As a result of the confirmatory factor analysis, it was determined that the distribution of the items in the Multidimensional Observation Scale for Elderly Subjects to the subscales was similar to the distribution in the original scale. Furthermore, reliability values of the scale and its subscales are adequate. Conclusion: It is thought that the Turkish form of the scale can be used to evaluate multidimensional and determine the cognitive, psychological and social functionings of older adults who are in institutional care or live with their families in Turkey.
- by haldun soygur and +1
- •
- Functional Analysis, Elderly, Moses
A ripiprazol, günümüzde klinik uygulamada kullan›lan ikinci kuflak antipsikotik ilaçlar içinde dopamin D2 reseptörleri üzerinde k›smi agonistik özelli¤i olan ilk ilaçt›r. Bu yönü ile bir bak›ma üçüncü kuflak antipsikotik olarak... more
A ripiprazol, günümüzde klinik uygulamada kullan›lan ikinci kuflak antipsikotik ilaçlar içinde dopamin D2 reseptörleri üzerinde k›smi agonistik özelli¤i olan ilk ilaçt›r. Bu yönü ile bir bak›ma üçüncü kuflak antipsikotik olarak nitelenebilecek olan aripiprazol-'ün sahip oldu¤u etki profili sadece bu özelli¤i ile de s›n›rl› de¤ildir. Klinik olarak pozitif ve negatif belirtiler üzerinde, di¤er antipsikotik ilaçlar ile benzer etkililik gösterdi¤i saptanm›flt›r. fiizofrenideki biliflsel ifllev bozukluklar›n›n düzelmesinde etkili oldu¤unu bildiren yay›nlar vard›r. Özellikle ekstrapiramidal yan etkiler, metabolik sendrom aç›s›ndan daha az risk tafl›mas› ve prolaktin kan düzeyinde art›fla neden olmamas› ari