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Objective: Combined antipsychotic treatment is frequently used in clinical practice either to improve the symptom control or to reduce the severity of side effects. The expected benefits by combining different antipsychotics include active cross-titration and co-utilization of different administration routes of the therapeutic agents. However, except the add-on therapies to clozapine, there is no objective evidence implying the superiority of combined therapy over monotherapy. Furthermore, there are a number of published case reports of significant side effects accompanying combined antipsychotic usage such as extrapyramidal and metabolic symptoms, seizures, and electrocardiographic abnormalities. It is also argued that switching into a new therapeutic agent might be more beneficial than augmenting the ongoing medication by polypharmacy. Here, we studied on a group of hospitalized schizophrenia patients in a training and research hospital in Turkey whether the Positive and Negative Symptom Scale (PANSS) scores differ between the patients under monotherapy and combined therapy. Methods: Hospital records belonging patients with schizophrenia who were followed up between the years of 2003 and 2013 were retrieved. Schizophrenia diagnoses were re-evaluated and confirmed according to the DSM-IV-TR criteria. All the patients who met the diagnostic criteria and having PANSS subscale scores (n=158) were included in the study. PANSS scores at the time of hospitalization are represented by adding “-before” suffixes, while the ones at the time of discharge by adding “-after”. Results: Our series composed of 158 schizophrenia patients (54 women and 104 men). When the medications were reviewed, we found that 66 patients (41.8%) were treated with a single drug and the atypical antipsychotics were the most commonly used group. Multiple drugs were combined on 92 patients (58.2%) and the most common combination was the “atypical + typical” antipsychotics. PANSS subscales and their comparisons among the groups of monotherapy and combined therapy revealed a slight statistical difference in PANSS negative scores at the time of hospitalization, although we found no significant changes in terms of PANSS scales, in general. Conclusion: In this study, we presented the overall frequency and patterns of our combined antipsychotic therapy in our daily routine work. We only used severity of symptoms in our study, and observed no differences between mono and combined therapy groups in terms of the PANSS evaluation. Further clinical studies with clinical, metabolic, and laboratory data as well as the long follow-ups are needed to uncover if combined therapy proves to be beneficial over monotherapy.

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

Many patients diagnosed with bipolar disorder respond incompletely or unsatisfactorily to available treatments. Defining refractoriness in bipolar disorder is a complex issue and should concern and include either every phase and pole or the disorder as a whole. There are only limited and sometimes confusing data on the treatment of refractory bipolar patients. The objective of this paper was to review the evidence for treatment options in treatment resistant patients on depressive, manic attack and maintanence phase as found in randomized controlled trials and with special attention to the definition and assessment of treatment resistance.

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.

OZETGiris: Sizofreni hastalarinda eslik eden kisilik bozuklukla-riyla sik karsilasilmakta ve bunlar belirtilerin gorunumu ile hastaligin seyrini degistirebilmektedirler.Amac: Sizofreni hastalarindan olusan bir orneklemde kisilik bozukluklarinin sikligini ve cesitli sosyodemografik ve klinik degiskenlerle iliskisini arastirmak amaclanmistir. Kisilik bozukluklarinin psikotik hastaliklarin tanisi, seyri, takibi ve tedavi planlamasina olasi etkileri tartisilmistir.Yontem: Calisma grubu sizofreni tanisiyla takip edilmekte olan 37 kadin ve 38 erkek (toplam 75) hastadan olusmaktadir. Hastalarin demografik, sosyal ve cesitli klinik testlerle degerlendirilen hastalik belirtilerinin durumu ile eslik eden kisilik patolojilerini iceren bir veri seti elde edilmistir.Bulgular: Sizofreni hastalarinda yaklasik %70 oraninda eslik eden bir veya birden fazla kisilik bozuklugu oldugu saptanmistir. En sik gorulen kisilik bozukluklari kacingan, paranoid ve obsesif-kompulsif kisilik bozukluklaridir. Kisilik bozukluklarinin tipl...

Guns are historically steady components of Turkish culture and traditions. However, the implementation of regulations about firearms is relatively recent. The major legislative breakthrough in the control of the acquisition and possession of firearms was the passage of Law no. 6136 about firearms and knives and other weapons on July, 10, 1953. Turkey is also party to two international conventions aimed at controlling the production, import, export, acquisition, and possession of firearms; however, although signed, these conventions are still not ratified. Moreover, in Turkey, psychiatrists are designated as experts in the process of gun licensing. Their appointed mission is to determine whether the applicant has any psychopathology that might prevent him or her from obtaining a gun license. Although the process to be followed for gun licensing is, in theory, clearly stated and determined in a circular distributed in 1997, there are many shortcomings in practice that await rectification. Data about gun pro...

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 (p

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.

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.

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. Methods: Two hundred and four consecutive patients completed a questionnaire including a demographic and clinical data form, HADS, and were examined with the Structured Clinical Interview for DSM-IV (SCID). The screening performance of HADS was investigated by calculating the area under the receiver operating characteristics curves (AUC), rates of specificity, and sensitivity. Results: For MDD; the AUC was 0.77 on the HADS total, the AUC was 0.79 on the HADS depression subscale, and was 0.72 on the anxiety subscale. For ADs; the results were 0.74, 0.74, and 0.70 respectively. Findings indicated that a HADS total cut-off score of ⩾17 to be optimal in identifying cases of MDD. This cut-off score offered a sensitivity of 0.70 and a specificity of 0.80. Findings suggested that a HADS total cut-off score of 10 was the optimal combination of sensitivity (0.84) and specificity (0.55) for ADs. When compared with SCID, the percentage of cases identified by HADS was 28% for MDD and 22% for ADs. Conclusions: Compared with SCID, HADS was found to have acceptable levels of sensitivity and specificity in detecting psychiatric morbidity especially for MDD and HADS can be recommended with reservations as a screening tool for breast cancer patients. Copyright © 2007 John Wiley & Sons, Ltd.

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.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.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.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.

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.

IntroductionIt 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.Materials and methodsData belonging to 27 female and 23 male schizophrenic patients (n=50) followed-up in our outpatient clinic constituted our series. Any patients having a history of mental retardation, head injury, prior neurological illness, alchohol or substance abuse were excluded. All patients were in a clinically stable phase of illness, and having no changes in medication for at least three months. Having obtained informed consent, patients were administered the Structured Clinical Interview for DSM-IV (SCID) as well as the Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Hamilton Axiety Scale (HAM-A), Calgary Depression Scale for Schizophrenia, Global Assessment of Functioning (GAF), and The Structured Clinical Interview for DSM III-R Axis II Personality Disorders.ResultsThirty-six schizophrenia patients had at least one kind of comorbid personality disorder (72%) while 14 (28%) had not. Comparing the patients having personality disorders to the rest of our patient population, we have found no statistically significant differences in age groups, clinical variables and functioning.DiscussionWe have shown that approximately three fourths of our series accompanied by at least one type of personality disorders, a finding consolidating and concordant with some of the previous works.

Approximately 1.7% of all epileptic seizures are induced by drugs, mostly psychotropics. Although the risk is known to be the lowest, a few reports notified quetiapine-induced epileptic convulsions. We report two additional cases.Case 1Twenty-five-year old man suffering from paranoid psychosis was given quetiapine for persisting symptoms. He also had myoclonic disorder which has become worse just after administering quetiapine. Physical, neurological and laboratory findings were normal. He once had a generalized seizure in our clinic. The electroencephalography (EEG) revealed an epileptic focus on frontal region. He has been diagnosed as frontal lobe epilepsy exacerbated by quetiapine. He has recovered and was doing well after withdrawn the drug.Case 2Twenty-three-year old women who had bipolar disorder was hospitalized due to a manic episode. Physical examination and routine laboratory tests were normal. Lithium at 600mg/d and quetiapine at 300 mg/d were started. Quetiapine has been gradually increased up to 900 mg/d at which the myoclonic symptoms first noted. They were disappeared after quetiapin was tapered to 600 mg/d. To control manic symptoms, quetiapine dosage had to be increased up to 700 mg/d again, but myoclonus was reappeared. Quetiapin was replaced with risperidon and manic symptoms subsided. No myoclonic seizures were noted during follow-up.ConclusionEEG abnormalities particularly likely with clozapine and olanzapine, moderate with risperidone, and the lowest with quetiapine. The risk of quetiapine-induced epilepsy was estimated as 0.75%. Evaluating of patients for the epileptic background is important in selecting proper antipsychotic medication.