First-line drugs for obsessive-compulsive disorder (OCD) pharmacotherapy are selective serotonin reuptake inhibitors (SSRI). The medication must be continued for at least 12 weeks at an effective ...dosage to find the most effective SSRI. For treatment, the drug dose should be titrated to the highest tolerated dose. The manufacturer's recommended maximum dose of fluvoxamine is 300 mg per day. We reported remission after about 1 month of 600 mg (high dose) fluvoxamine, which was tolerated by a patient with OCD. The patient continued at this dose for 3 months and remained in remission.
This study aimed to study the effect of maintenance electroconvulsive therapy (mECT) on hospitalization rates in patients who had been readmitted after acute courses of electroconvulsive therapy ...(ECT), and determine the most frequently used treatment schedules in mECT. Patients who had undergone mECT treatment for the last 5 years were retrospectively reviewed. Seventy patients were included in the study. The control group of 70 patients was selected from patients who received only acute ECT. Of the patients in the mECT group, 55.8% (39) were female, and 41.4% (29) were diagnosed with major depressive disorder. The mean number of patients hospitalized who received mECT after acute ECT was 0.55 ± 0.87, whereas it was 1.13 ± 1.31 in patients who received only pharmacotherapy after ECT in a covariant analysis adjusted for age and diagnosis. The most commonly used initial treatment protocol of mECT was weekly × 4, biweekly × 2, and monthly × 6. mECT is more effective in reducing hospitalization after acute ECT treatments than using psychotropic drugs alone for maintenance therapy.
Psikojenik polidipsi veya kendiliğinden indüklenen su zehirlenmesi, kompulsif su içimini tanımlamak için kullanılır. Mental hastalıklarda nadir görülen bir durum değildir. En sık kronik şizofrenide ...görülür. Tedavisi etiyolojiye ve tablonun ciddiyetine göre düzenlenir. Hafif vakalarda su kısıtlaması ve hastanın eğitimi yeterlidir, ağır olgularda tedavide su kısıtlaması, tuz solüsyonu infüzyonu, diüretikler, hiponatremi kaynaklı nöbetlerin kontrolünün sağlanması için antikonvülsan ilaç uygulaması yapılır. Akut klinik tablonun tedavisinden sonra altta yatan primer psikiyatrik hastalığın tedavisi yeniden düzenlenmelidir. Bu yazıda şizofreni tanısıyla 14 yıldır takip edilen ve psikojenik polidipsi tanısı alan ve amisülpirid tedavisi ve sıvı kısıtlaması ile başarıyla tedavi edilen 39 yaşında bir erkek hasta sunulmuştur.
Psychogenic polydipsia or self-induced water poisoning is used to describe compulsive drinking. It is not a rare condition in mental disorders. Chronic schizophrenia is the most common reason. Treatment should be organized according to the etiology and severity of the case. In mild cases, water restriction and patient education is sufficient, but In severe cases, are recommended water restriction, salt solution infusion, diuretics and application of anticonvulsant drugs to control hyponatremia-induced seizures. The treatment of the underlying primary psychiatric disease should be rearranged after the treatment of the acute clinic symptoms. In this article, we present a 39-year-old male patient with a diagnosis of chronic schizophrenia with psychogenic polydipsia and was treated successfully with amisulpride and fluid restriction.
Amaç: Bu çalışmada, yaygın anksiyete bozukluğu tanılı hastalarının bilişsel çarpıtmalarının tedavi uyumuna etkisi-nin belirlenmesi amaçlanmıştır. Yöntem: Araştırma 20.01.2019-20.05.2019 tarihleri ...arasında Gaziantep Üniversi-tesi Şahinbey Araştırma ve Uygulama Hastanesi Psikiyatri Polikliniği’ne ayaktan ve yatarak tedavi edilmek üzere başvuran yaygın anksiyete bozukluğu hastaları ile yapılmıştır. Değerlendirme için Bireysel Bilgi Formu, Bilişsel Çarpıtmalar Ölçeği ve Morisky Tedavi Uyum Ölçeği kullanıldı. Hastalar tedavi uyumu düşük olanlar ve orta/yüksek olanlar şeklinde iki gruba ayrılarak bilişsel çarpıtmaları değerlendirilmiştir. Bulgular: Çalışmaya katılan 96 hastanın %20.8’inin 25-29 yaş aralığında olduğu, %46.9’unun evli olduğu, %35.4’ünün ilköğretim düzeyinde eğitim gördüğü saptanmıştır. Kişilerarası ilişkiler ile ilgili bilişsel çarpıtmalar ve başarı değerlendirmesi ile ilgili çarpıtmaların toplam değerlendirmesinde tedavi uyumu ile bilişsel çarpıtmalar arasında anlamlı bir ilişki saptanmamıştır (p>0.05). Bilişsel çarpıtmaların tek tek değerlendirmesinde tedavi uyumu düşük olanların kişilerarası ilişkilerde olumluyu azım-sama/yok sayma bilişsel çarpıtmaları daha yoğun olduğu saptanmıştır (p=0.03). Sonuç: Olumluyu azımsama/yok sayma bilişsel çarpıtması tedavi uyumu ile negatif ilişkilidir. Farmakoterapi ve bilişsel terapi kombine tedavisinde öncelikli olarak olumluyu azımsama/yok sayma ile ilgili çarpıtmaların belirlenmesi ve terapilerde öncelik verilmesi tedavinin etkinliğine katkıda bulunabilir.
According to preoperative anesthesia consultations of the patients, 62.1% (n=36) were assessed to be in ASA 2 risk group and 34.5% (n=20) in ASA 3 risk group. Yaşlılık, elektrokonvülzif tedavi, ...güvenilirlik INTRODUCTION Electroconvulsive therapy is a somatic treatment method that is widely used throughout the world for various psychiatric disorders that are severe and resistant to treatment.1 Studies show that ECT is used in various populations and indications, and it is one of the most effective treatment methods that provide the fastest response in the treatment of depression, bipolar disorder and psychosis in geriatric patients. 2'3 ECT is a saving in some life-threatening conditions such as catatonia, neuroleptic malign syndrome, intense suicidal thoughts, refusal to eat and uncontrollable mania.4-6 It is observed that drug tolerance in the geriatric population is low due to age-related pharmacokinetic changes, and increased sensitivity to drug side effects such as anticholinergic effects and orthostatic hypotension. ...ECT is an advantageous treatment option in geriatric patients especially from the aspect of toxic presentations and drug interaction potential due to multiple drug use and comorbid diseases.7 In some studies conducted on patients with late onset geriatric depression and coexisting cerebral small vessel disease, it was shown that the efficacy of medical treatment was lower.8 It was demonstrated that response to ECT was better in geriatric patients who more frequently have neuropsychiatric comorbidities as compared to younger patients.9'10 Although it is very well known that ECT is an effective and reliable treatment option, it is a less preferred treatment option in geriatric patients in many places throughout the world. According to ASA risk classification, mortality rate in ASA 2 risk group and ASA 3 risk group patients is 0.27-0.4% and 1.8-4.3%, respectively.23'24 Our data show that complication rate was higher in ASA 3 patients than ASA 2 patients as expected (p=0.040).
Background
The objective of this study is to measure the levels of sestrin-2 (SESN2) and hypoxia-inducible factor-1 alpha (HIF-1α), which can be determinants in the relevant physiopathology and ...etiology, assessment of the clinical severity, and identification of new treatment targets in major depressive disorder (MDD) and its subtypes.
Methods
A total of 230 volunteers, including 153 patients diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and 77 healthy controls, were included in the study. Of the MDD patients included in the study, 40 had melancholic features, 40 had anxious distress features, 38 had atypical features, and the remaining 35 had psychotic features. All participants were administered the Beck’s Depression Inventory (BDI) and Clinical Global Impressions-Severity (CGI-S) scale. Serum SESN2 and HIF-1α levels of the participants were measured using the enzyme-linked immunosorbent assay (ELISA) method.
Results
The HIF-1α and SESN2 values of the patient group were found to be significantly lower than those of the control group (
p
< 0.05). The HIF-1α and SESN2 values were significantly lower in patients with melancholic, anxious distress, and atypical features compared to the control group (
p
< 0.05). The HIF-1α and SESN2 levels did not differ significantly between patients with psychotic features and the control group (
p
> 0.05).
Conclusion
The findings of the study suggested that knowledge of SESN2 and HIF-1α levels may contribute to the explanation of the etiology of MDD, objective assessment of the severity of the disease, and identification of new treatment targets.
Purpose: The aim of this study was to investigate the levels of anxiety, health anxiety and somatosensory amplification in patients who presented with the clinical manifestation of Carpal Tunnel ...Syndrome (CTS) without electromyography findings.
Materials and Methods: Patients who applied to the Physical Therapy and Rehabilitation outpatient clinic, respectively, and were diagnosed with CTS with clinical findings were included in the study. The patients who were determined to have no evidence of conduction loss in EMG were evaluated by using Short Health Anxiety Inventory (HAI-18), SomatoSensory Amplification Scale (SSAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ).
Results: A total of 111 participants were included in the study, of whom 56 were patients and 55 were healthy control subjects. There was no significant difference between the patient and control groups in terms of age, gender, and body mass index (BMI). A statistically significant relationship was observed between these scales and the VAS, BCTQ symptom-severity and BCTQ function status in the positive direction.
Conclusion: In our study, it was shown that the patient group showed higher anxiety, health anxiety and somatosensory amplification characteristics, and these features were associated with the severity of the CTS clinical scales. Studies with large-scale samples are needed to be carried out to confirm the results of this study.
Amaç: Bu çalışmada Karpal Tunel Sendromu (KTS) klinik tablosu ile başvuran ve Elektromyografi (EMG) sonucunda sinir iletimi normal tespit edilen hastalarda anksiyete, sağlık anksiyesi ve somatosensoryel amplifikasyon düzeylerinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya Fizik Tedavi ve Rehabilitasyon polikliniğine sırasıyla başvurmuş klinik bulgular ile KTS tanısı konulan hastalar alındı. EMG’de iletim kaybı bulgusu olmayan hastalara Sağlık Anksiyetesi Ölçeği-18 (HAI-18), Bedensel Belirtileri Abartma Ölçeği (BBAÖ), Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ), Görsel Ağrı Skalası (VAS) ve Boston Karpal Tünel Sorgulama Anketi (BKTSA) uygulandı.
Bulgular: Çalışmamız 56 hasta, 55 kontrol olmak üzere 111 vakadan oluştu. 42 erkek olmak üzere, 69 vaka kadın cinsiyetteydi. Hasta ve kontrol grubu arasında yaş, cinsiyet, beden kitle indeksi (BKİ) açısından anlamlı bir farklılık yoktu. Uygulanan ölçekler ile VAS, BKTSA semptom şiddeti ve BKTSA fonksiyonel durum arasında pozitif yönde anlamlı ilişki gözlendi.
Sonuç: Çalışmamız ile bu hasta grubunun yüksek anksiyete, sağlık anksiyetesi ve somatosensoryal amplifikasyon özellikleri gösterdiği ve bu özelliklerin KTS klinik ölçeklerinin şiddeti ile ilişkili olduğu gösterilmiştir. Mevcut sonuçlarımızı doğrulamak için daha geniş örneklemlerde çalışmalara ihitiyaç vardır.
Accumulated evidence has demonstrated abnormal amygdala activation in bipolar disorder (BD). The olfactory bulb (OB) has vigorous connections with the amygdala. Although odor-related functions of the ...OB decreased during the evolutionary process, we hypothesized that an evolved OB with increased activation in emotion regulation may be one of the main factors affecting amygdala functions in BD. Our aim was to investigate metabolism in the OB and amygdala in patients with BD. Twenty-six patients diagnosed with BD according to DSM-5 diagnostic criteria were included in this cross-sectional study. Metabolism in the OB and amygdala was assessed using fluorodeoxyglucose positron emission tomography/CT in patients with BD. The OB and amygdala metabolism was compared with the patients’
Z
scores. Both OB and amygdala metabolic activities were significantly higher than in the controls. A positive correlation was detected between right/left amygdala metabolism and right OB metabolism (
p
< 0.05, r:467 and r:662, respectively). This study increased our understanding of the etiopathogenesis of BD. In BD, the main cause of hypermetabolism in the amygdala may be increased metabolism in the OB. During evolution, the OB may have assumed a dominant role in emotional processing rather than olfactory functions.
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