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Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). The purpose of our study was to compare the dose of propofol in valproateusing patients with valproate free patients. In an open study, 17 patients with bipolar affective disorder manic episode who were to be treated with valproate and ECT combination, compared with 16 manic episode patients who were to be treated with ECT but not valproate. Two groups were compared on the basis of electroencephalography-registered seizure duration and propofol dosage required to induce anesthesia. Valproate, as compared with valproate free group, results in a decrease in propofol dose necessary to induce anesthesia. In valproate group, seizure duration was significantly shorter than valproate free group. In recent studies during the ECT of patients with schizophrenia, propofol was shown to possess significant seizure-shortening properties. When the clinician needs to prolong seizure length in patients under valproate treatment, interruption of valproate treatment or using an anesthetic agent other than propofol should be considered. The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episode. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. [ABSTRACT FROM AUTHOR]

Transcranial direct stimulation is a noninvasive brain stimulation method. Although exact mechanism is not known; depolarization and increase in spontaneous neuronal activity in the cell membrane occurs by anodal stimulation; decrease in neuronal activity occurs by cathode stimulation. In this study, files of the hospitalized and outpatient patients on whom transcranial direct stimulation was performed in a psychiatry hospital between December 2011 and September 2012 were evaluated. The mean age of the patients was 45,7 years. 14 of the cases were males (48,3%) and 15 were (51,7%) females. The mean duration of disease history was 7,8 years. Diagnostic distribution was as follows; major depressive episode (n=8 cases); dementia comorbid with depression (n=5); bipolar affective disorder-depressive episode (n=5); panic disorder (n=4); bipolar affective disorder -hypomanic episode (n=3); obsessive compulsive disorder comorbid with depression (n=2); alcohol addiction comorbid with depression with psychotic features (n=1). Response to treatment with tDCS was evaluated with brief psychiatric rating scale in all patients. Hamilton depression rating scale (HAM-D) was used for the evaluation of those patients with depression in addition to BPRS. A paired-samples t test was performed to evaluate the effectiveness of tDCS yielding a significant decrease in post treatment BPRS scores (p= .001) and HAM-D scores (p=.003). Patients were also receiving pharmacotherapy and psychotherapy which might have been responsible for the clinical improvement, however the aim of this study is not to evaluate clinical efficacy. Generally, transcranial direct stimulation is considered an option in cases in whom additional brain stimulation treatments such as electroconvulsive therapy is needed but at the same risky for the patient or in cases unresponsive to these therapies. [ABSTRACT FROM AUTHOR]

Objective: A significant revision in criteria related to bipolar disorder in DSM-5 has been done. This study evaluated the impact of these changes on diagnosis and reviewed the challenges that clinicians and researchers will encounter in the use and implementation of DSM-5 criteria for bipolar disorder. Methods: The sample consisted of a total of 82 patients (50 women and 32 men) with a diagnosis of bipolar disorder according to DSMIV, with an average age of 36.9±10.8 years. All participants had been monitored in our outpatient department for at least 2 years and during that time had received a diagnosis of bipolar disorder. Their last episodes were reviewed according to DSM-5 criteria and changes in diagnosis are evaluated. Results: When using the DSM-5 criteria, there was an increase in the number of cases diagnosed with manic episode compared to using the DSM-IV TR criteria (43 vs. 24 cases). As DSM-5 does not include a mixed episode diagnosis, a portion of the cases (69.3%) diagnosed with mixed episode according to DSM-IV TR were diagnosed with manic episode/additional feature by DSM-5, with the remaining cases 30.7% described as undefined/additional feature Conclusion: Our results suggest that an additional 18.2% of bipolar disorder patients met the diagnostic threshold for manic episode when using DSM-5 criteria, compared to previous criteria. Clinical trials may now also need to focus on treatment effects in patient groups with or without mixed features. Medications that are efficient in treating mixed episodes defined according to DSM-IV TR may also be useful in treating mixed features as defined by DSM-5, but further studies will be required to assess this assumption. [ABSTRACT FROM AUTHOR]