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Objective: The objective of this study is to investigate the reproductive characteristics and sexual functions in bipolar patients monitored in a specialized mood disorder clinic, identify their potential relationship with the use of psychotropics, and investigate gender differences. Method: The study included 193 patients (100 men, 93 women) with a DSM-IV diagnosis of bipolar disorder being followed at Ege University Affective Disorders Outpatient Unit. Reproductive characteristics of the patients were examined at the evaluation. Sexual dysfunctions were evaluated using the International Index of Erectile Function in men and Arizona Sexual Experience Scale in women. Results: There was no significant difference between men and women regarding age, duration of marriage, duration of illness, duration of mood stabilizer and antipsychotic drugs use and dosage of antipsychotic drugs. Age at pubarche in men was 13.8±1.2 years, age at menarche in women was 13.2±1.3 years. Current menstrual cycle irregularities were found in 15.1% (n=14) of women. Prevalence of lifetime menstrual irregularities was 38.7% (n=36). 60.4% (n=67) of patients having an active sexual life were using an effective contraception method. 31.7% (n=26) of female patients had sexual dysfunction whilst 52% (n=39) of male patients had erectile dysfunction. In both men and women, no significant difference was found between groups using mood stabilizers and antipsychotic drugs in terms of sexual dysfunction. There was no correlation between sexual function scores and usage and duration of mood stabilizers and antipsychotic drugs in either sex. Conclusions: This cross-sectional study with a relatively large bipolar sample group concluded that the patients’ reproductive and sexual functions were not as much affected by bipolar disorder and psychotropic drug use as had been assumed. However, these results should be supported with prospective and controlled trials.

WOS: 000404296300004, PubMed ID: 28680307, Introduction: Lithium has many effects on thyroid physiology. Although these side effects have been known for a long time, large sample studies of lithium-treated patients using ultrasonography are lacking. The aim of this study is to investigate the detailed thyroid mor-phologies, hormone levels, and antibodies of lithium-treated patients compared with healthy controls. Methods: This cross-sectional study involved 84 lithium-treated patients with bipolar disorder and 65 gender and age similar controls who had never been exposed to lithium. Subjects between 18 and 65 years of age were eligible for the study. Venous blood samples were acquired to determine the levels of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid antibodies; also, ultrasonographic examinations of the patients' thyroid glands were performed. Results: There were no statistically significant differences in smoking habits, known thyroid disease, thyroid medication use, familial thyroid disease, fT4 level, autoimmunity, thyroid nodule presence, or Hashimoto's thyroiditis between the lithium and control groups. The median TSH level and thyroid volume were significantly higher in the lithium group. In the lithium group, 14 cases (16.7%) of hypothyroidism, seven cases (8.3%) of subclinical hypothyroidism, and one case (1.2%) of subclinical hyperthyroidism were defined; in the control group, seven cases (10.8%) of hypothyroidism and two cases (3.1%) of subclinical hyperthyroidism were defined. Thyroid dysfunction, goiter, parenchymal abnormality, ultrasonographically defined thyroid abnormality, and thyroid disorder were found to be more prevalent in the lithium group. 90% of patients with goiter and 74.3% of patients with ultrasonographic pathologies were euthyroid. Conclusion: It is important to note that 90% of the patients with goiter were euthyroid. This indicates that monitoring by blood test alone is insufficient. The prevalence rates of 47.6% for goiter and 83.3% for ultrasonographic pathology demonstrate that ultasonographic follow-up may be useful in lithium-treated patients. To determine whether routine ultrasonographic examination is necessary, large sample prospective studies are necessary due to the limitations of this study., Ege University Scientific Research Project Grant; Psychiatric Association of Turkey, This study was supported by Ege University Scientific Research Project Grant and Psychiatric Association of Turkey.

Objective Studies indicate that serotoninergic and noradrenergic pathophysiological mechanisms may underlie both alcohol abuse/dependence and depressive disorder. The purpose of this study was to evaluate and compare the effectiveness and tolerability of two serotonergic and noradrenergic antidepressant drugs-mirtazapine and amitriptyline, for the treatment of patients with alcohol dependence co-morbid with depressive disorder in a randomized, double-blind treatment setting. Methods Forty-four patients were included in the study. Twenty-four patients were randomized to mirtazapine and twenty to amitriptylinegroups. Thirty-six of them completed the study. The 17-item Hamilton Depression Rating Scale (HDRS), the Spielberger State-Trait Anxiety Inventory (STAI) and alcohol craving questionnaire were used at baseline and, at days 7, 14, 28, 42, and 56 to estimate the effectiveness of the antidepressant treatment. Michigan Alcoholism Screening Test (MAST) was used in the assessment of alcohol dependence. The tolerability was assessed with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU). Results There was significant improvement in HDRS and alcohol craving scores with both the drugs. However there were no statistical differences between treatment groups. Mirtazapine was tolerated better than amitriptyline treatment. Conclusions The treatment with either mirtazapine or amitriptyline resulted with the reduction of HDRS and craving scores. The side-effect profile of mirtazapine was relatively favorable in our study. Copyright # 2008 John Wiley & Sons, Ltd. key words—alcohol dependence; depressive disorder; mirtazapine; amitriptyline; co-morbidity

The medial frontal cortex has been shown to modulate emotional behavior and stress responses, suggesting that the dysfunction of this region may be involved in the pathogenesis of depressive symptoms. The present study was performed to determine whether there was any effect of antidepressant treatment on the metabolite levels in the left medial frontal cortex as measured by proton magnetic resonance spectroscopy in depressed patients. Twenty patients diagnosed as having major depressive disorder according to DSM-IV and 18 healthy volunteer subjects were included in the study. Twelve of patients had their first episode and were drug-naïve. Other depressed patients were drug-free for at least 4 weeks. The severity of depression was assessed by HAM-D and Clinical Global Impression Scale-Severity (CGI-S). Single voxel, 8 cm(3), 1H MR spectra of left medial frontal cortex was acquired both before and following antidepressant treatment. The concentrations and ratios of N-acetyl aspartate (NAA), Creatine+Phosphocreatine (Cr+PCr) and Choline (Cho) were measured. Pretreatment NAA/Cr values of patients were lower than those of healthy controls, but this difference did not reach to statistically significant levels (t=1.83, df=36, p=0.07). However, antidepressant treatment had significant effect on NAA/Cr ratios (groupxtreatment interaction: F=9.93 df=1,36, p=0.03). After the treatment, NAA/Cr values of patients increased significantly compared to pretreatment values (t=3.32, df=19, p=0.004). No significant difference was observed between the post-treatment NAA/Cr values of patients and those of controls (t=1.64, df=36, p=0.19). Correlation analysis detected negative correlation between pretreatment CGI-S scores and NAA/Cr ratios (r=-0.51, p=0.02). This preliminary result suggests that there might be a possible defect in the neuronal integrity in the left medial frontal cortex (mainly left anterior cingulate cortex) of depressed patients. Antidepressant treatment with its neurotrophic effects might play a positive role in restoring the neuronal integrity. Further studies are needed to support these initial findings.

Background: The aims of this study were to identify the dominant affective temperamental characteristics of patients with bipolar disorder (BP) and their clinically well first-degree relatives and to compare the prevalence rates of these temperaments with those in healthy control subjects. Methods: One hundred bipolar I probands and their 219 unaffected first-degree relatives were enrolled in the study. The control group consisted of healthy subjects without any personal or family history of bipolar disorder, matched with the age and gender of the probands and first-degree relatives. To identify the dominant affective temperaments, the Turkish version of TEMPS-A scale was used. Results: At least one dominant temperament was found in 26% of the proband group, in 21.9% of the relative group, and 6.0% and 10.0% of the control groups, respectively. The most noteworthy finding was that both the probands and their relatives had significantly higher frequency of hyperthymic temperament than the controls. Limitations: Temperament had not been assessed premorbidly in the probands with bipolar disorder. Conclusions: The study supports the familial, possibly genetic, basis for the hyperthymic temperament in the genesis of bipolar I dosorder. That the cyclothymic temperament was not similarly represented, may be due to the higher specificity of the cyclothymic temperament to the bipolar II sybtype (which we did not study). More research is needed on the relevance of cyclothymic and other temperaments to the genetics of bipolar disorders selected by rigorous subtyping along the clinical spectrum of bipolarity.

Background Recently it was proposed that nitric oxide metabolites (NO) may have a role in the pathophysiology of schizophrenia and major depressive disorders. The present study was performed to assess changes in serum nitric oxide metabolite levels in schizophrenic patients compared with healthy controls. Our secondary aim was to further evaluate the impact of psychopharmacologic treatment on circulating NO levels not assessed previously. Methods Serum NO levels of patients with schizophrenia (n = 20) before and after 6 weeks of treatment were compared with those of healthy controls (n = 20). Severity of schizophrenia and response to treatment were assessed with positive and negative symptoms of schizophrenia. NO levels were estimated by Griess method in serum samples. Results In patients with schizophrenia, pre-treatment serum NO levels were higher than those of control subjects (39.15 ± 18.24 vs. 25.40 ± 5.83 μmol/L, p = 0.036) and also of post-treatment values (34.41 ± 16.35 vs. 25.40 ± 5.83 μmol/L, p = 0.049), respectively. However, no significant difference was found between serum NO levels in pre- and post-treatment values. Conclusions Our findings of increased serum NO levels in schizophrenic patients confirmed the role of NO in the pathophysiology of schizophrenia. However, we found that antipsychotic drugs do not reveal significant effects on serum levels of NO in schizophrenia in a 6-week treatment regimen. Further studies with longer therapy periods may suggest some new clues for novel treatment strategies employing antioxidants and NOS inhibitors in schizophrenia.

Objective: In the present study, we aimed to evaluate menstrually related symptom changes in euthymic women with treatment-responsive bipolar disorder (BD) compared with healthy control subjects and investigate the presence of premenstrual dysphoric disorder (PMDD). Methods: Thirty-four euthymic women with treatment-responsive BD on mood-stabilizers (lithium and/or valproate) for at least 6 months and 35 control subjects with no history of medical/mental disorder between ages of 18 and 35 years with regular menstrual cycles were prospectively followed up for at least two consecutive menstrual cycles using the Daily Record of Severity of Problems-Short Form (DRSP). Each subject was administered the retrospective self-report questionnaire, Premenstrual Assessment Form (PAF), in the first postmenstrual phase of the menstrual cycle. Venous blood samples were collected between 19 and 22 days of menstrual cycle to evaluate ovulation by measuring the serum progesterone levels. Results: The differences in mean age, age of onset of menses, cycle length and bleeding length did not appear to be significantly meaningful between groups. In the retrospective assessment of premenstrual symptom changes, controls complained more than women with BD. More controls showed a 30% change in DRSP and in depressive and physical sub-groups than the women with BD. Controls demonstrated a significant increase compared with treatment-responsive BD patients in total, depressive, anxiety and attention sub-group scores of DRSP from the postmenstrual to the premenstrual phase, whereas the scores of vegetative symptoms of controls and women with BD did not differ significantly during one cycle or both. Significant menstrual cycle effect was observed in both groups. Conclusion: Within the limitations of the study, the results suggest that ongoing mood-stabilizing treatment may have a prophylactic effect against premenstrual symptom changes in women with treatment-responsive BD.

Background: Although several studies have documented the existence of psychopathology in obese adolescents, disagreement remains regarding the extent and nature of this psychopathology. The aim of the present study was to explore the type and frequency of psychopathology in a clinical as well as a non-clinical sample of obese adolescents, and in a normal weight control group. Methods: The study sample consisted of a clinical study group of 30 obese adolescents, a non-clinical obese group of 30 obese adolescents, and a control group of 30 normal weight adolescents. Psychological assessment was performed using a non-structured psychiatric interview, the Child Behavior Checklist (CBCL), Children Depression Inventory (CDI), Rosenberg Self-esteem scale (SES) and the Eating Attitude Test (EAT). Results: More than half of the clinical obese adolescents (16/30) had a DSM-IV diagnosis, often involving major depressive disorder (n = 10). The mean scores of anxiety-depression, social problems, social withdrawal and total problem in the CBCL scale of the clinical obese group were significantly higher than the non-clinical obese group and the normal weight control group. The mean total scores of the SES and the CDI of the clinical obese group were higher than the normal weight control group. The mean total score of EAT of the clinical obese group was significantly higher than the normal weight control group, and the mean score of EAT of the non-clinical obese group was significantly higher than the normal weight control group. Conclusions: The results support previously published reports which show a higher ratio of psychopathology (depression, behavioral problems, low-esteem) among clinical obese adolescents than among non-clinical obese adolescents. Findings provided evidence for a psychosocial at-risk population in a subgroup of obese adolescents.

Objective: Evidence indicates that valproate (VPA) may have an adverse impact on reproductive endocrine and metabolic functions in women with epilepsy. This study explores whether the association of VPA with reproductive endocrine abnormalities is applicable to women with bipolar disorder (BD) or is unique to women with epilepsy. Methods: Thirty female patients aged 18–40 years with a DSM-IV diagnosis of BD (15 on lithium monotherapy and 15 on VPA monotherapy or VPA in combination with lithium therapy) and 15 with idiopathic generalized epilepsy (IGE) on VPA monotherapy were evaluated for reproductive endocrine functioning and metabolic parameters. Results: The menarche age, mean length of menstrual cycle and mean length of menses were not significantly different between groups. None of the bipolar patients on lithium, three (20%) of the bipolar patients on VPA and seven (47%) of the epileptic patients on VPA reported menstrual disturbances. Hirsutism scores of the epilepsy group were significantly higher than those bipolar women, regardless of treatment. Serum total testosterone levels were significantly higher in patients (both with BD and with IGE) treated with VPA than in those treated with lithium. Serum FSH levels were significantly lower and LH-to-FSH ratio was significantly higher in patients with epilepsy than in patients with BD, regardless of treatment. The weight parameters and lipid values investigated did not differ significantly between the groups. Conclusion: The study supports the conclusion that VPA may be associated with menstrual abnormalities and increased total testosterone levels in both bipolar and epileptic patients although women with BD did not show clinical features of hyperandrogenism (menstrual abnormalities, hirsutism and truncal obesity) as did frequently as women with epilepsy.

WOS: 000297959300008, Efficacy of low-dose pramipexole augmentation in the treatment of refractory psychotic depression complicated with tardive dyskinesia: a case report Tardive dyskinesia (TD) is a severe complication of antipsychotic treatment. Pramipexole can be effective in the treatment of TD due to its D3 dopamine receptor agonist effect. Studies conducted in bipolar depression and treatment-resistant depression (TRD), support the antidepressant effect of pramipexole. Here we present the case of a 55 year-old female. For the treatment of depression, she received antidepressants, anxiolytics and antipsychotics for 2.5 years. When severe bruxism, fidgeting, and serious functional impairment emerged, she was re-hospitalized and diagnosed with TRD and TD. Several combinations of antidepressants, anxiolytic, and antipsychotics were administered. The depression improved partially, but hypochondriac preoccupations and dyskinesia persisted. At the sixth month, pramipexole 0.125 mg/day was added to sertraline 200 mg/day, amitriptyline 60 mg/day, clonazepam 2 mg/day, and biperiden 4 mg/day. The depression and dyskinesia improved and she was discharged. TRD and TD improved within the first 4 weeks of pramipexole administration and no relapse was observed. Pramipexole is a promising agent in the treatment of TRD and TD.

The effects of valproate on male reproductive hormones have been studied in epileptic patients and animals, but the results are inconsistent because reproductive hormone abnormalities may be independent of the use of valproate and may be due to epilepsy itself. The aim of this study was to determine if there is an association between valproate and reproductive abnormalities in men with bipolar disorder or if the association is unique to men with epilepsy.The study included 39 male patients aged 18-50 years with a DSM-IV diagnosis of bipolar disorder (21 on lithium monotherapy and 18 on valproate monotherapy or valproate in combination with lithium therapy) and 15 male epilepsy patients on valproate monotherapy that were evaluated in terms of reproductive hormones.Duration of illness, duration of lithium and valproate therapy, daily dose and serum concentrations of lithium and valproate, duration of marriage, spouse's gravidity, the serum estradiol, luteinizing hormone, sex hormone-binding globulin, and free testosterone levels, and the free testosterone:luteinizing hormone ratio were not significantly different between the groups. Serum prolactin and follicle-stimulating hormone levels were significantly higher in the epilepsy patients than in the bipolar disorder patients on lithium monotherapy.The findings show that valproate did not have a negative effect on male reproductive hormones in the bipolar patients. The elevated prolactin and follicle-stimulating hormone levels observed in the epilepsy group should be attributed to epilepsy. To the best of our knowledge this is the first study to compare reproductive hormones in bipolar disorder and epilepsy patients on valproate therapy.

Amaç: Valproatın erkek üreme hormonları üzerine etkisi epilepsi hastalarında ve hayvanlarda çalışılmıştır. Sonuçlar çelişkilidir, çünkü üreme hormonlarındaki değişiklikler valproat kullanımından bağımsız olarak epilepsi hastalığıyla ilişkili olabilir. Bu çalışmanın amacı, valproat sağaltımıyla ilişkilendirilen üreme hormonlarındaki değişikliklerin bipolar bozukluk tanılı erkek hastalarda görülüp görülmediğini araştırmaktır. Yöntem: 18-50 yaş arası, DSM-IV’e göre bipolar bozukluk tanılı 39 erkek hasta (21’i sadece lityum, 18’i valproat ile birlikte lityum veya sadece valproat kullanan) ve sadece valproat kullanan idiyopatik jeneralize epilepsi tanılı 15 erkek hastanın üreme hormon değerleri karşılaştırıldı. Bulgular: Hastalık süreleri, ortalama lityum ve valproat kullanım süreleri, ortalama lityum ve valproat günlük doz ve serum düzeyleri, evlilik süresi ortalamaları, eşlerinin gebelik sayıları, serum östradiol, lüteinize edici hormon, seks hormon bağlayıcı globulin, serbest testosteron düzeyleri ve serbest testosteron/lüteinize edici hormon oranı açısından gruplar arasında anlamlı fark yoktu. Serum prolaktin ve folikül stimüle edici hormon düzeyleri epilepsi tanılı hasta grubunda lityum kullanan bipolar bozukluk tanılı hasta grubuna göre anlamlı olarak daha yüksekti. Sonuç: Bulgular, valproatın erkek üreme hormonları üzerine olumsuz etkisinin olmadığını göstermektedir. Epilepsi grubunda görülen prolaktin ve folikül stimüle edici hormon düzeylerindeki yükseklik epilepsi hastalığına atfedilebilir. Bu çalışma, literatürde valproat sağaltımının bipolar bozukluk ve epilepsi tanılı erkek hastalarda üreme hormonlarına etkisini karşılaştıran ilk çalışmadır., Objective: The effects of valproate on male reproductive hormones have been studied in epileptic patients and animals, but the results are inconsistent because reproductive hormone abnormalities may be independent of the use of valproate and may be due to epilepsy itself. The aim of this study was to determine if there is an association between valproate and reproductive abnormalities in men with bipolar disorder or if the association is unique to men with epilepsy. Materials and Method: The study included 39 male patients aged 18-50 years with a DSM-IV diagnosis of bipolar disorder (21 on lithium monotherapy and 18 on valproate monotherapy or valproate in combination with lithium therapy) and 15 male epilepsy patients on valproate monotherapy that were evaluated in terms of reproductive hormones. Results: Duration of illness, duration of lithium and valproate therapy, daily dose and serum concentrations of lithium and valproate, duration of marriage, spouse’s gravidity, the serum estradiol, luteinizing hormone, sex hormone-binding globulin, and free testosterone levels, and the free testosterone:luteinizing hormone ratio were not significantly different between the groups. Serum prolactin and follicle-stimulating hormone levels were significantly higher in the epilepsy patients than in the bipolar disorder patients on lithium monotherapy. Conclusion: The findings show that valproate did not have a negative effect on male reproductive hormones in the bipolar patients. The elevated prolactin and follicle-stimulating hormone levels observed in the epilepsy group should be attributed to epilepsy. To the best of our knowledge this is the first study to compare reproductive hormones in bipolar disorder and epilepsy patients on valproate therapy.

Significant sex differences have been described for mental disorders in terms of prevalence, symptom presentation and prescription of psychotropic medication. Most of the published studies and reviews emphasize the impact of female-specific reproductive events on the course of the mental illness or sex difference of the adverse effects of psychotropic medication or the concerns about treatment of female patients during the perinatal period. Different from other reviews, we will summarize the effects of current mental disorder/psychotropic medication on the female-specific reproduction-related events (such as menstrual regularity, pregnancy, postpartum period and menopause).A number of recent studies have highlighted the adverse effects of psychotropic agents on the female reproductive system, especially on the regularity of the menstrual cycle or on the female gonadal hormones. Without any medication, disturbances of the female gonadal system are observed especially among severely mentally ill female patients. In the studies, the prevalence of female-specific gonadal abnormalities and their mechanism of action, prevention and recommendations are given in detail.The field of reproductive psychiatry is rapidly evolving. There is increasing evidence that clinicians should be aware of female medical health while treating severely mentally ill female patients. Analyzing the present data will further advance our understanding of treatment safety and impact of untreated mental illness in women.

The prevalence of bipolar disorder (BD) in males and females is almost equal. The onset of BD in females typically occurs during the reproductive years, complicating its treatment. Although it was once believed that pregnancy prevents recurrence, studies have shown that recurrence is common and severe during pregnancy. On the other hand, the effects of pharmacological treatment on obstetrical outcome are not well known and some of these agents are considered teratogenic. Thus, the decision to treat pregnant patients with psychotropic agents requires solving an ethical dilemma. Risk-benefit decisions should be made while considering both the risk of relapse of BD and its morbidity, and the risk of fetal exposure to psychotropic medications. Moreover, the risk of recurrence increases dramatically in the postpartum period. It is well known that all of the psychotropic medications studied enter the breast milk. Thus, their effects on infants should be considered while prescribing for a breastfeeding mother. The aim of this review was to discuss the safety profiles of the treatment options for pregnant and breastfeeding BD patients. Firstly, each medication's effects on organ dysgenesis, neonatal toxicity, and neurobehavioral development, and their associated adverse events during pregnancy and the postpartum period are discussed, with a focus on the emerging literature. Given this background, practical suggestions on tailoring treatment in BD patients, from preconception to breastfeeding are highlighted.

Valproate is an antiepileptic commonly used in the treatment of psychiatric and neurologic diseases. Some of the most frequently seen side effects affect the gastrointestinal, neurological, and hematological systems. Its side effects on reproductive functions have not been sufficiently studied. The use of valproate by females with bipolar disorder and epilepsy may cause menstrual cycle abnormalities, polycystic ovary syndrome, and hyperandrogenism. The effects on male reproductive functions have been researched only in epileptic patients and animals, and the results have been conflicting, because reproductive function abnormalities may be independent of the use of valproate and may be due to epilepsy itself. In the first part of this review reproductive function abnormalities due to epilepsy will be discussed, independent of the use of valproate or any other antiepileptic. Then, the results of research on valproate's effects on male reproductive functions (hormonal levels and sperm parameters) will be presented, including the possible underlying mechanisms of these effects, the effect of the duration of valproate use, and whether or not the effects are reversible. In the second section we review the results of animal research, which could be beneficial in assessing the effects of valproate and epilepsy.

Despite a wide range of various drugs, a significant proportion of depressed bipolar patients fail to respond to the treatment strategies. Novel theraupetics for bipolar depression are needed. Preliminary studies suggest that pramipexole a dopaminergic agent that has been used in the treatment of Parkinson's disease and restless leg syndrome may have antidepressant properties in unipolar and bipolar depressed patients as well as neurotrophic properties. The optimal antidepressant daily dose of pramipexole is not known. It has been suggested to be used between 0.125 to 9.0 mg/day. In double blind placebo controlled bipolar depression treatment studies, the average daily dose of pramipexole was 1.7 mg. Manic switches have been reported with depressive subjects and with subjects without any mental disorders. We report two cases of treatment resistant bipolar depression. Despite different treatment strategies and treatment adherence, the patients did not give optimal response to the treatments and continue to experience depressive relapses. They have been treated with low dose (0.5-0.75 mg/day) pramipexole augmentation successfully. The severity and the duration of the depressive episodes were decreased. No serious adverse event has been reported with pramipexole during the maintenance treatment.

WOS: 000208663800430, …

The genetic phenomenon of anticipation is a pattern of inheritance that includes earlier age at onset and increased severity of symptoms in succeeding generations, and is a feature of some neurodegenerative diseases. This phenomenon is suggested to occur in bipolar disorder (BP) as well.Anticipation in children with BP type 1 (s2) (n = 31) and their parents (s1) (n = 31) not-consecutive generations-was assessed by analyzing clinical characteristics and prognoses.Age at onset of BP type 1 in s2 (mean: 19.3 +/- 4.2 years) occurred earlier than in s1 (mean: 29.5 +/- 10.2 years) (u = 345, P0.001). There was a direct negative correlation between the s1 and s2 cases (r = -0.554, P0.001). The total number of episodes in s1 (13.9 +/- 12.3) was greater than in s2 (8.7 +/- 7), which had a higher frequency of episodes (0.6 +/- 0.3 and 1.5 +/- 1.2) (u = 357, P0.001). There was a direct correlation between total episodes and the frequency of manic episodes between s1 and s2 (r = 0.312, P0.001 and r = 0.365, P0.001, respectively). We observed that 72.7% of BP type 1 parents that had episodes with psychotic features had offspring that had episodes with psychotic features.Results of this study show that age at onset was earlier and the frequency of episodes was greater in s2 BP type 1 cases. In addition, episodes with psychotic features might be a marker for genetic anticipation.

The purpose of this talk is to review the literature and our studies concerning impact of female reproductive cycle on the course of bipolar disorder. The literature concerning following topics is reviewed: the relation between menstrual cycle and mood fluctuations (the impact of puberty on the onset of the illness, the relation between specific menstrual cycle phase and specific mood episode, prevalence of premenstrual syndrome among women with bipolar disorder); the impact of pregnancy and postpartum period on the course of bipolar disorder; and whether menopoause is a risk factor for bipolar women or not. The data suggest that hormonal fluctuations are associated with increased risk of mood fluctuations and mood episodes in women with bipolar disorder. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007

Our aim was to review evidence of the role of cognitive deficits in bipolar disorder and their relationship to other factors, such as disorder variables, treatment, additional diagnoses, genetic risk, and brain imaging findings.Studies that examined cognitive dysfunction in bipolar disorder and its relationship to the variables of clinical, genetic, and bipolar disorder subtypes, as well as neuro-anatomical and neuro-functional evidence have been reviewed. Findings from our own studies have also been used while conducting the review.In bipolar disorder, deficits in executive functions, memory, and attention persist in the euthymic state. The number of episodes and the course of the disorder seem to be related to the severity of memory dysfunction and psychomotor slowness. However, symptoms of cognitive dysfunction are present at the onset of the disorder. Moreover, cognitive dysfunction has been observed in the healthy relatives of bipolar disorder patients. Cognitive dysfunction in bipolar disorder is associated with functional and possibly structural anomalies in some parts of the brain, such as the frontal and cingulate cortex. Some recent studies reported a relationship between symptoms of cognitive dysfunction and genetic variations in bipolar disorder.Today, the presence of cognitive deficits in bipolar disorder is widely accepted; however, evidence of the neurobiological and clinical correlates of cognitive symptoms is still limited. More studies are needed to investigate the relationship between cognitive dysfunction in bipolar disorder and risk. Genetic studies are just now amending our body of knowledge. There have been many conflicting results reported by brain imaging studies. Different brain imaging approaches and genetic methods should be used with more specific cognitive and social-emotional tasks for increasing our knowledge about the nature of cognitive deficit in bipolar disorder.

Amaç: Antisipasyon (birikme etkisi) adı verilen kalıtım kalıbı bir hastalıkla etkilenmiş bireylerde ardışık nesillerde daha erken başlangıç yaşı ve daha yüksek hastalık şiddeti ile birliktelik gösterir. BP bozuklukta da birikme etkisi görüngüsünün geçerli olabileceği öne sürülmüştür. Yöntem: Bu çalışmada birikme etkisinin değerlendirilmesi amacı ile iki uçlu bozukluk tip 1 tanılı hem çocukta (s2= 31) hem de ebeveynde-anne ya da baba- (s1= 31) ardışık iki nesilde hastalığın klinik özellikleri ve gidişi incelenmiştir. Bulgular: s2?de hastalığın başlangıç yaşı (19.3±4.2) s1?den (29.5±10.2)düşük bulunmuştur (u= 345, p< 0.001). Birinci ve ikinci nesil olguların başlangıç yaşları arasında negatif yönde doğrusal bir ilişki mevcuttur (r= 0.554, p< 0.001). Toplam dönem sayısı s1?de s2?den daha çok sayıda iken (13.9±12.3 ve 8.7±7), toplam dönem oranı s2?de (0.6±0.3 ve 1.5±1.2) daha yüksektir (u= 357, p< 0.001). Birinci ve ikinci nesil olguların toplam dönem oranları ve manik dönem oranları arasında doğrusal bir ilişki vardır (r= 0.312, p< 0.001 ve r= 0.365, p< 0.001). Psikotik bulgulu ebeveynlerin % 72.7?inin çocuklarının da psikotik bulgulu dönem yaşadığı saptanmıştır. Sonuç: Bu çalışmanın sonuçlarına göre, iki uçlu bozuklukta birikme etkisi, ikinci nesilde başlangıç yaşının daha erken ve dönem sıklığının daha fazla olması yönünde doğrulanmaktadır. Buna ek olarak psikotik bulgulu dönemler birikme etkisinin bir değişkeni olarak önerilmektedir., Objective: The genetic phenomenon of anticipation is a pattern of inheritance that includes earlier age at onset and increased severity of symptoms in succeeding generations, and is a feature of some neurodegenerative diseases. This phenomenon is suggested to occur in bipolar disorder (BP) as well. Method: Anticipation in children with BP type 1 (s2) (n= 31) and their parents (s1) (n= 31)­?consecutive generations?was assessed by analyzing clinical characteristics and prognoses. Results: Age at onset of BP type 1 in s2 (mean: 19.3 ± 4.2 years) occurred earlier than in s1 (mean: 29.5 ± 10.2 years) (u = 345, P < 0.001). There was a direct negative correlation between the s1 and s2 cases (r = ?0.554, P < 0.001). The total number of episodes in s1 (13.9 ± 12.3) was greater than in s2 (8.7 ± 7), which had a higher frequency of episodes (0.6 ± 0.3 and 1.5 ± 1.2) (u = 357, P < 0.001). There was a direct correlation between total episodes and the frequency of manic episodes between s1 and s2 (r = 0.312, P < 0.001 and r = 0.365, P < 0.001, respectively). We observed that 72.7% of BP type 1 parents that had episodes with psychotic features had offspring that had episodes with psychotic features. Conclusions: Results of this study show that age at onset was earlier and the frequency of episodes was greater in s2 BP type 1 cases. In addition, episodes with psychotic features might be a marker for genetic anticipation.

Amaç: Bu yazıda, bipolar bozuklukta görülen bilişsel belirtilerin doğası ve hastalık değişkenleri, tedavi, ek tanı, genetik risk, beyin görüntüleme bulguları gibi diğer faktörlerle ilişkisine yönelik kanıtları gözden geçirmek amaçlanmıştır. Yöntem: Bipolar bozuklukta remisyonda gözlenen bilişsel işlev bozukluklarını inceleyen çalışmalar gözden geçirilmiştir. Daha sonra, bu bulguların yukarıda bahsedilen faktorlerle ilişkisini inceleyen çalışmalar ele alınmıştır.Bulgular yorumlanırken, kendi çalışmalarımızdan elde edilen verilerden de yararlanılmıştır. Bulgular: Bipolar bozuklukta, yürütücü işlevler, bellek ve dikkat gibi alanlardaki sorunlar iyilik dönemlerinde de sürmektedir. Hastalık dönem sayısı ve süresi, bellek bozukluğunun ve psikomotor yavaşlamanın şiddetiyle ilişkili görülmektedir. Ancak bilişsel belirtiler hastalığın başlangıcında da mevcuttur. Bipolar bozukluğu olan bireylerin sağlıklı akrabalarında da bilişsel bozukluklar saptanmıştır. Bipolar bozuklukta bilişsel bozukluk, frontal korteks, singulat korteks gibi beyin bölgelerinin işlevsel ve belki de yapısal anomalisiyle ilişkilidir. Birkaç yeni çalışma, bipolar bozuklukta bilişsel belirtiler ve bazı genetik varyasyonlar arasında bir ilişki bildirmiştir. Sonuç: Bipolar bozuklukta bilişsel belirtilerin varlığı artık yaygın olarak kabul görmektedir. Ancak, bilişsel belirtilerin nörobiyolojik ve klinik karşılıklarına ilişkin veriler halen kısıtlıdır. Bipolar bozuklukta bilişsel bozukluğun hastalık riskiyle ilişkisini inceleyen daha çok çalışmaya ihtiyaç vardır. Genetik çalışmalar henüz emekleme aşamasındadır. Beyin görüntüleme çalışmalarında da birçok çelişkili sonuç bildirilmiştir. Bu konuda ilerleme kaydetmek için, farklı beyin görüntüleme teknikleri ve genetik yöntemlerin, daha özgül ve sosyal-emosyonel yetileri de hedefleyen bilişsel görevlerle birlikte kullanılması gereklidir., Objective: Our aim was to review evidence of the role of cognitive deficits in bipolar disorder and their relationship to other factors, such as disorder variables, treatment, additional diagnoses, genetic risk, and brain imaging findings. Method: Studies that examined cognitive dysfunction in bipolar disorder and its relationship to the variables of clinical, genetic, and bipolar disorder subtypes, as well as neuro-anatomical and neuro-functional evidence have been reviewed. Findings from our own studies have also been used while conducting the review. Results: In bipolar disorder, deficits in executive functions, memory, and attention persist in the euthymic state. The number of episodes and the course of the disorder seem to be related to the severity of memory dysfunction and psychomotor slowness. However, symptoms of cognitive dysfunction are present at the onset of the disorder. Moreover, cognitive dysfunction has been observed in the healthy relatives of bipolar disorder patients. Cognitive dysfunction in bipolar disorder is associated with functional and possibly structural anomalies in some parts of the brain, such as the frontal and cingulate cortex. Some recent studies reported a relationship between symptoms of cognitive dysfunction and genetic variations in bipolar disorder. Conclusion: Today, the presence of cognitive deficits in bipolar disorder is widely accepted; however, evidence of the neurobiological and clinical correlates of cognitive symptoms is still limited. More studies are needed to investigate the relationship between cognitive dysfunction in bipolar disorder and risk. Genetic studies are just now amending our body of knowledge. There have been many conflicting results reported by brain imaging studies. Different brain imaging approaches and genetic methods should be used with more specific cognitive and social-emotional tasks for increasing our knowledge about the nature of cognitive deficit in bipolar disorder

Objectives: Cognitive dysfunctions in several domains were proposed to be trait markers of bipolar patients. The aim of this study was to evaluate the effect of previous psychotic features on neuropsychological measures, including sustained attention, in remitted bipolar patients. Methods: The study participants were 40 euthymic psychotic, 25 non-psychotic bipolar I patients and 30 healthy control subjects. Participants were assessed with a battery of neuropsychological tests targeting attention, executive functions, psychomotor speed, verbal learning and memory. Results: Euthymic psychotic bipolar patients performed worse than controls on most of the measures, after controlling for the confounding effects of education, age and residual symptoms. Non-psychotic patients were also impaired on tasks of attention, fluency and psychomotor speed. ‘Number of Wisconsin Card Sorting Test (WCST) categories’ achieved was the only measure on which psychotic patients performed significantly worse compared to non-psychotic patients. Differences among patient groups were not explained by illness severity measures. The duration of illness was related to slowness in psychomotor speed tasks. Verbal memory deficits may be related to serum lithium levels and age of onset of disease. Conclusions: Deficits in cognitive flexibility may be a candidate for being a trait marker of psychotic features among bipolar patients. However, verbal fluency, psychomotor speed and sustained attention deficits may be candidates for vulnerability indicators of bipolar disorder in general.

The authors aimed to investigate cognitive performance of first-degree relatives of probands with bipolar disorder (BD). They hypothesized that the relatives of BD patients would have impaired performance on cognitive tests of frontal-executive functions. A neuropsychological battery was administered to 34 first-degree relatives of BD probands and 25 control subjects. Relatives showed significant impairment in verbal working memory and executive function. Verbal memory and psychomotor performances of relatives were not different from control subjects. One particular component of executive function, cognitive flexibility, was associated with family history of mood episodes with psychotic features. Verbal working memory and executive function deficits may be useful endophenotypic markers of genetic vulnerability to BD. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

This paper will present a review of the literature on the relationship between the menstrual cycle and mood disorders.We performed a MEDLINE search of the Turkish and English language literature for the years 1955-2005 using the following terms: depression, bipolar disorder, premenstrual syndrome, premenstrual exacerbation, premenstrual dysphoric disorder, menstrual cycle, and suicide. Earlier reports had shown higher psychiatric admission during premenstrual period of the menstrual cycle and higher prevalence of suicide attempts during specific phase of the menstrual cycle.Women of reproductive age with mental disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest that for a subset of women there is a relationship between phases of the menstrual cycle and increased vulnerability for an exacerbation of ongoing mood disorders (especially major depressive episode) or the development of a new episode. The question of whether the direction of mood shifts in the course of bipolar disorder is associated with specific cycle phase has been raised, albeit with limited and inconsistent data.There are a limited number of studies to elucidate these relationships and most of them lack prospective assessments, include the small number of patients and use unreliable methods of determining menstrual-cycle phases. Additionally, many reports do not specify whether the exacerbations reflect an aggravation of the underlying mood disorder or a new subset of symptoms that occur only during certain phases of the menstrual cycle. Further studies should provide more information about the contribution of premenstrual fluctuation or worsening to increased illness severity of mood disorder and treatment resistance.

Sustained attention deficits are proposed to be both state and trait indicators of bipolar disorder. The nature of these deficits and their association with medication and symptoms is not clear yet. The aim of this study was to investigate the impairments in various components of sustained attention task in euthymic and manic patients and was to investigate the relationship between the deficits in the manic state and medication effects. The performances of 37 manic patients, 34 euthymic patients with bipolar disorder and 34 control subjects on eight scores from Conners' CPT II, reflecting three different dimensions of sustained attention were compared. Similar to some recent findings, euthymic patients had decreased target sensitivity (omission errors) and response time inconsistency. The increased false responding (commission errors), perseveration and vigilance deficits were prominent in the manic patients. These state dependent impairments could not be explained by the impact of medication. In contrast, the exacerbation of seemingly trait-related impairments in the manic state can be at least partly explained by the impact of pharmacological therapy. (c) 2006 Elsevier Inc. All rights reserved.

Amaç: Bu yazıda, adet döngüsü ve duygudurum bozuklukları arasındaki ilişki ile ilgili kanıtların sunulması amaçlanmıştır. Yöntem: Depresyon, iki uçlu bozukluk, premenstrüel sendrom, premenstrüel alevlenme, premenstrüel disforik bozukluk, adet döngüsü ve özkıyım anahtar sözcükleri kullanılarak 1955-2005 yılları arasında İngilizce ve Türkçe yayınlanmış tüm makaleler incelenmiştir. İlk çalışmalarda adet öncesi dönemde psikiyatri kliniklerine başvuruda artış olduğu ve özkıyım davranışı ile belirli bir adet döngüsü evresi arasında ilişki olduğu gösterilmiştir. Bulgular: Verilere göre ruhsal bozukluğu olan üreme çağındaki kadınların hastalık belirtileri, adet döngüsü sırasında dalgalanır. Bazı veriler, bir grup kadın hastanın, adet döngüsünün belirli bir evresinde var olan ruhsal hastalıklarının (özellikle de majör depresif dönem) alevlenmesi veya yeni bir hastalık dönemi yaşaması açısından yatkınlık artışı gösterdiklerini ileri sürmüştür. İki uçlu duygudurum bozukluğunun gidişinde duygudurum dalgalanmalarının yönü ile belirli bir adet döngüsü evresi arasında ilişki olup olmadığı sorusu ortaya atılmıştır, ancak konu ile ilgili veriler kısıtlıdır ve tutarlı değildir. Sonuç: Az sayıda çalışma bu ilişkiyi açıklamaya çalışmış, çoğunda belirtiler ileriye dönük değerlendirilmemiştir; çoğu, az sayıda hasta içermektedir ve adet döngüsünün evresini belirlemek için güvenilir inceleme yöntemleri kullanılmamıştır. Ek olarak, pekçok çalışmada adet öncesi (premenstrüel) kötüleşmenin altta yatan hastalığın alevlenmesini mi, yoksa sadece adet döngüsünün belirli bir evresinde ortaya çıkan yeni belirtileri mi yansıttığı belirlenmemiştir. Gelecek çalışmalarda ruhsal hastalığın adet öncesi dalgalanmasının anlamı veya duygudurum bozukluğunun hastalık şiddetini artırması ve sağaltıma direnci ile ilgili bilgilere daha çok yer verilmelidir., Objective: This paper will present a review of the literature on the relationship between the menstrual cycle and mood disorders. Method: We performed a MEDLINE search of the Turkish and English language literature for the years 1955-2005 using the following terms: depression, bipolar disorder, premenstrual syndrome, premenstrual exacerbation, premenstrual dysphoric disorder, menstrual cycle, and suicide. Earlier reports had shown higher psychiatric admission during premenstrual period of the menstrual cycle and higher prevalence of suicide attempts during specific phase of the menstrual cycle. Results: Women of reproductive age with mental disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest that for a subset of women there is a relationship between phases of the menstrual cycle and increased vulnerability for an exacerbation of ongoing mood disorders (especially major depressive episode) or the development of a new episode. The question of whether the direction of mood shifts in the course of bipolar disorder is associated with specific cycle phase has been raised, albeit with limited and inconsistent data. Conclusion: There are a limited number of studies to elucidate these relationships and most of them lack prospective assessments, include the small number of patients and use unreliable methods of determining menstrual-cycle phases. Additionally, many reports do not specify whether the exacerbations reflect an aggravation of the underlying mood disorder or a new subset of symptoms that occur only during certain phases of the menstrual cycle. Further studies should provide more information about the contribution of premenstrual fluctuation or worsening to increased illness severity of mood disorder and treatment resistance.

The aim of the present study was to investigate the relationship between affective temperaments and clinical features in bipolar disorder. Testing the relationships between phenomenological features, course, severity of episodes, overall severity of illness and comorbid conditions would clarify the reliability and validity of affective temperamental descriptions.One hundred patients with bipolar I disorder were recruited from consecutive admissions and evaluated when euthymic. Affective temperaments were assessed with TEMPS-A Turkish version. Information about the characteristics of each patient's illness was obtained from three main sources; interview with patient (SCID-I), interview with at least one close relative and patient records. We compared the clinical features of patients with and without a specific affective temperament.Similar rates of cyclothymic, hyperthymic and irritable temperaments were observed in bipolar patients. Five important findings of the present study were (1) hyperthymic temperament was more frequent in males than females; (2) manic switches were more frequent among bipolar patients with hyperthymic temperament; (3) psychotic features were more common in the irritable temperament group; (4) comorbid conditions, (mostly alcohol use disorders) were more common among bipolar patients with cyclothymic temperament; and (5) bipolar patients with irritable temperament were more likely to have a manic episode at the onset of illness.These findings suggest that affective temperaments have significant clinical implications in bipolar disorder, beyond the genetic basis and predisposing factors. There were significant differences between patients with different affective temperaments in terms of gender, type of first episode, psychotic symptoms, switch and comorbidity.

Objective: i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non-ToM cognitive deficits on ToM abilities. Method: Forty-three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition. Results: The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention. Conclusion: Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.

Amaç: Bu çalışmanın amacı mizacın, bipolar bozukluğun görünümü, hastalığın gidişi ile ilgili özellikleri ve ektanı ile ilişkisinin araştırılmasıdır. Yöntem: Bu çalışmada birimimizde en az bir yıldır ve düzenli olarak izlenen bipolar tanılı 100 hasta değerlendirilmiştir. Olağan kontrolleri için polikliniğe başvuran ve çalışmaya katılmayı kabul eden, ataklar arası dönemdeki hastalar ardışık olarak çalışmaya alınmıştır. Bilgiler hasta, en az bir hasta yakını ve birime ait izlem dosyalarından elde edilmiştir. Her hastaya SCID-I Görüşmesi ve Memphis, Pisa, Paris ve San Diego Mizaç Değerlendirme Anketi’nin Türkçe formu uygulanmış ve hazırlanan bilgi formu ile hastalığın görüngüsel özellikleri, gidişi ve ektanı ile ilgili bilgiler toplanmıştır. Her bir mizaç özelliği olan ve olmayan hastalar arasında, klinik özelliklerin farklılık gösterip göstermediği araştırılmıştır. Bulgular: Bipolar bozukluk tanılı hastalarda siklotimik, hipertimik ve sinirli (irritabl) mizaç benzer oranlarda saptanmıştır. Hipertimik mizaç erkeklerde daha sık gözlenmiştir. Sinirli mizacı olan hastaların ilk hastalık dönemleri daha sıklıkla manidir. Yine sinirli mizaçlı hastalarda, psikotik bulgulu manik, depresif ya da karma dönem varlığı daha sıktır. Manik kayma, hipertimik mizaç grubunda daha sık iken, ektanı siklotimik mizaç grubunda daha sık bulunmuştur. Sonuç: Bu çalışmadan elde edilen bulgular farklı afektif mizaç özelliklerine sahip bipolar hastalarda, hastalığın farklı klinik ve gidiş özellikleri taşıdığını göstermektedir., Objective: The aim of the present study was to investigate the relationship between affective temperaments and clinical features in bipolar disorder. Testing the relationships between phenomenological features, course, severity of episodes, overall severity of illness and comorbid conditions would clarify the reliability and validity of affective temperamental descriptions. Methods: One hundred patients with bipolar I disorder were recruited from consecutive admissions and evaluated when euthymic. Affective temperaments were assessed with TEMPS-A Turkish version. Information about the characteristics of each patient’s illness was obtained from three main sources; interview with patient (SCID-I), interview with at least one close relative and patient records. We compared the clinical features of patients with and without a specific affective temperament. Results: Similar rates of cyclothymic, hyperthymic and irritable temperaments were observed in bipolar patients. Five important findings of the present study were (1) hyperthymic temperament was more frequent in males than females; (2) manic switches were more frequent among bipolar patients with hyperthymic temperament; (3) psychotic features were more common in the irritable temperament group; (4) comorbid conditions, (mostly alcohol use disorders) were more common among bipolar patients with cyclothymic temperament; and (5) bipolar patients with irritable temperament were more likely to have a manic episode at the onset of illness. Conclusion: These findings suggest that affective temperaments have significant clinical implications in bipolar disorder, beyond the genetic basis and predisposing factors. There were significant differences between patients with different affective temperaments in terms of gender, type of first episode, psychotic symptoms, switch and comorbidity.

Amaç: Bu çalışmada, depresif bozukluk tanılı genç kızlarda adet öncesi belirtilerin dağılımını ve şiddetini tanımlamak, depresyon şiddeti ile adet öncesi belirti şiddeti arasındaki ilişkiyi değerlendirmek, sağlıklı genç kızlarla belirti dağılımı ve şiddeti açısından fark olup olmadığını ortaya koymak amaçlanmıştır. Yöntem: Ege Üniversitesi Tıp Fakültesi Çocuk Psikiyatrisi Polikliniği’ne başvuran, DSM-IV’e göre yapılan klinik görüşmeler sonucunda “depresif bozukluk” tanısı konan ve Beck Depresyon Ölçeğinden 17 ve üzerinde puan alan 40 genç kız (depresif bozukluk grubu) ve sağlıklı 37 genç kız (kontrol grubu) çalışmaya alınmıştır. Premenstruel Değerlendirme Formu (PDF) ile adet öncesi belirtiler geriye dönük olarak değerlendirilmiştir. Bulgular: Depresif bozukluk tanılı genç kızların adet öncesi belirtilerinin sağlıklı gruba göre daha şiddetli olduğu ve PDF’nun “yorgunluk” alt ölçeğinin önemli derecede daha fazla olduğu saptanmıştır. Depresif bozukluk şiddeti arttıkça adet öncesi belirtilerin şiddetinde de bir artış belirlenmiştir. Sonuç: Depresif belirtileri olan genç kızlar tedavi edileceğinde adet öncesi dönemdeki belirti farklılıklarını göz önünde bulundurmak, bu dönemde yaşanan duygusal, davranışsal ve fiziksel değişikliklerin daha iyi anlamak için yararlı olacaktır., Objective: The objective of this study was to identify premenstrual symptom distribution and its severity in adolescent girls diagnosed with depressive disorder, to assess the relationship between the severity of depression and premenstrual symptoms and to demonstrate whether or not there was difference between the healthy and depressed girls in terms of their premenstrual symptom distribution and severity. Methods: The subjects were 40 adolescent girls who applied to the Ege University, Faculty of Medicine, Department of Child Psychiatry and were diagnosed with depression after having been clinically interviewed according to DSM-IV and rated 17 or above at the Beck Depression Inventory. The control group consisted of 37 healthy adolescent girls. Premenstrual symptoms have been assessed retrospectively by means of Premenstrual Assessment Form (PAF). Results: It has been found that the premenstrual symptoms of the girls diagnosed with depression were ‘ more severe than those of the healthy group and the former scored considerably much more than the latter on the Tiredness’ sub scale of the PAF. An increase in the severity of premenstrual symptoms has been seen along with the increase in that of depression. Conclusion: When adolescent girls with symptoms of depressive disorder are to be treated, taking the differences in pre-menstrual symptoms into consideration will be useful for a better understanding of the emotional, behavioral and physical changes experienced in this period.

The aim of this study is to investigate whether depressive (DT), hyper thymic (HT), cyclothymic (CT), irritable and anxious temperaments as identified by Turkish version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire (TEMPS-A) are characteristic to depressive or bipolar disorder (BD) and to compare underlying affective temperamental differences.68 patients with recurrent major depression (MD-R), 50 patients with single episode major depressive disorder (MD-S), 84 euthymic bipolar patients and 100 healthy controls were included in the study and evaluated with TEMPS-A.There was a gender difference between patient groups. The females were more dominant in the MD-R group. The mean age of onset of illness of bipolar patients was lower than the depressive patients and the mean duration of illness of bipolar patients was longer than those of the MD-R patients. The prevalence of the rate of any dominant affective temperament was significantly higher in the MD-R group than other study groups. The prevalence rate and scores of DT were significantly higher both in MD-R and MD-S groups (25.0% and 12.0% respectively) than the BD group (2.4%) and control subjects (3.0%). The prevalence rate and scores of CT were higher among the patients groups than the controls. None of the subjects except BD patients had HT.With the limitations of the study, it is thus reasonable to speculate that affective temperament, to a degree, determine the nature and the existence of the mood disorders.

Researchers have reported that serum brain-derived neurotrophic factor (sBDNF) of drug-free depressed patients are lower than those of healthy controls and proposed that low sBDNF levels might reflect failure of neuronal plasticity in depression. In this study, we compared sBDNF levels of depressed patients (n = 28) before and after 8 weeks of antidepressant treatment, with those of healthy controls (n = 18) to test the hypothesis that initially low sBDNF levels of drug-free depressed patients will increase parallel with their clinical response to antidepressant treatment. The severity of depression and response to treatment were assessed with Hamilton Rating Scale for Depression (HAM-D). sBDNF was assayed with the sandwich ELISA method. Baseline sBDNF levels of patients (mean, 20.8 ng/ml; [S.D., 6.7]) were significantly lower than those of controls (mean, 26.8 ng/ml; [S.D., 9.3]; p = 0.015), and were negatively correlated with HAM-D scores (r = -0.49, p = 0.007). After 8 weeks of treatment, sBDNF levels of patients had increased significantly (mean, 33.3 ng/ml; [S.D., 9.9]; p < 0.001) and no longer differed from those of controls. These results support the hypothesis that BDNF might play a critical role in the pathophysiology of major depressive disorder and successful antidepressant treatment increases the attenuated BDNF levels in depressed patients.

Brain-derived neurotrophic factor (BDNF) has been suggested to be involved in the etiology of schizophrenia. There is a line of evidence that disruption of neurotrophins could play a role in the etiology of schizophrenia, and antipsychotics show their effect by altering levels of neurotrophins. The aim of this study was to evaluate the effect of antipsychotics on serum BDNF levels and their relationship with the symptoms in patients with schizophrenia. Twenty-two schizophrenia patients were enrolled in the study. The control group consisted of 22 age- and sex-matched physically and mentally healthy volunteers (7 male, 15 female). Serum BDNF levels and the positive and negative syndrome scale (PANSS) scores were recorded at baseline and after 6 weeks of treatment. Serum BDNF levels were also recorded in the control group. Schizophrenia patients who failed to meet 30% improvement in PANSS score were excluded from the study. The baseline serum BDNF levels of schizophrenia patients were lower than those of controls (t = 4.56; df = 21; p0.001). There was no correlation between serum BDNF levels and PANSS scores in patients with schizophrenia (p0.05). Although PANSS (for positive symptoms p0.001, for negative symptoms p0.001) and general psychopathology (t = 20.9; df = 22; p0.001) scores improved significantly after 6 weeks of antipsychotic treatment; there was no change in BDNF levels in patients' serum (p0.05). Our results support the view that BDNF would be associated with schizophrenia. However, we could not conclude that treatment with antipsychotics alters serum BDNF levels in patients with schizophrenia.

Amaç: Çalışmanın amacı Memphis, Pisa, Paris San Diego mizaç değerlendirme anketi (MPPS-MD) ile belirlenen depresif, hipertimik, siklotimik, irritabl ve anksiyöz mizaçların depresif bozukluk ya da iki uçlu duygudurum bozukluğuna (İU-DB) özgü olup olmadığını araştırmak ve çalışma grupları arasında duygulanım mizacı görülme sıklıklarını karşılaştırmaktır. Yöntem: 17 yaşından büyük ve iyilik döneminde olan 68 yineleyici tip depresyon (Y-MD), 50 tek dönemli depresyon (T-MD), 84 ötimik İU-DB hastası ve 100 sağlıklı kontrol çalışmaya alındı ve duygulanım mizaçları MPPS-MD ile değerlendirildi. Bulgular: Y-MD grubunda daha fazla kadın hasta olmak üzere hasta grupları arasında cinsiyet farklılığı vardır. İU-DB hastalarının hastalık başlama yaşları daha düşük ve toplam hastalık süreleri depresif hastalardan daha uzun bulundu. Y-MD grubunda herhangi bir baskın duygulanım mizacı daha sık gözlenmişti. Depresif hastaların depresif mizaç sıklığı ve puanları diğer gruplara göre daha yüksekti. Siklotimik mizaç, hasta gruplarında kontrollere göre daha sık gözlendi ve bu gruplardaki siklotimik mizaç puanları daha yüksek bulundu. Hipertimik mizaç ise sadece İU-DB hastalarında gözlendi. Sonuç: Bu çalışma bazı kısıtlılıklarına rağmen duygulanım mizaçlarının duygudurum bozukluklarının varlığı ve özelliklerini belirlediğine ilişkin kuramları desteklemektedir., Objective: The aim of this study is to investigate whether depressive (DT), hyperthymic (HT), cyclothymic (CT), irritable and anxious temperaments as identified by Turkish version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) are characteristic to depressive or bipolar disorder (BD) and to compare underlying affective temperamental differences. Method: 68 patients with recurrent major depression (MD-R), 50 patients with single episode major depressive disorder (MD-S), 84 euthymic bipolar patients and 100 healthy controls were included in the study and evaluated with TEMPS-A. Results: There was a gender difference between patient groups. The females were more dominant in the MD-R group. The mean age of onset of illness of bipolar patients was lower than the depressive patients and the mean duration of illness of bipolar patients was longer than those of the MD-R patients. The prevalence of the rate of any dominant affective temperament was significantly higher in the MD-R group than other study groups. The prevalence rate and scores of DT were significantly higher both in MD-R and MD-S groups (25.0% and 12.0% respectively) than the BD group (2.4%) and control subjects (3.0%). The prevalence rate and scores of CT were higher among the patients groups than the controls. None of the subjects except BD patients had HT. Conclusion: With the limitations of the study, it is thus reasonable to speculate that affective temperament, to a degree, determine the nature and the existence of the mood disorders.

One third of depressive patients show partial or no response to antidepressant treatment. With partial or nonresponders, treatment strategies are as follows: switching to another antidepressant, augmenting with other psychotropic agents, or combining antidepressants. There are no data in the literature about the positive effect of combining venlafaxine with selective serotonin reuptake inhibitors (SSRIs). In this report, the presented cases had been on at least two different classes of antidepressant medication (or combination of antidepressants) for an adequate time and dose. They showed only a partial response to high dose of venlafaxine but improved after the addition of an SSRI (sertraline, citalopram, or paroxetine) to venlafaxine. The combination treatment was well tolerated in all of the cases.

Amaç: Bu çalışmanın amacı bir seçici noradrenalin geri alım inhibitörü olan reboksetinin majör depresyon tanıh hastalarda etkinliği, güvenilirliği ve kabul edilebilirliğinin araştırılmasıdır. Aynı zamanda reboksetinin enerji, motivasyon ve sosyal işlevler üzerine düzeltici etkilerinin saptanması da hedeflenmiştir. Yöntem: Araştırma çok merkezli, açık bir klinik çalışma olarak gerçekleştirilmiştir. Onsekiz - 65 yaşları arasında bulunan, DSM-IV tanı ölçütlerine göre majör depresif bozukluk tanısı almış ve Hamilton Depresyon Derecelendirme Ölçeği (HAMD) puanı 20 ve üzeri olan toplam 44 hasta (10 erkek, 34 kadın) araştırmanın yürütüldüğü beş ayrı klinikte bu çalışmaya dahil edilmiştir. İlaçdan arındırma döneminin ardından tüm hastalar 8 hafta süreyle günde 8 mg reboksetin tedavisi almışlardır. Dördüncü haftadan sonra araştırmacıların kararıyla 10 mg/gün dozuna çıkılmıştır. Başlangıç değerlendirmesini takiben 1., 2., 4., 6. ve 8. haftalarda hastalar izlem görüşmelerine çağırılarak belirtilerdeki düzelme ve yan etkiler kaydedilmiştir. Tedavi etkinliğinin değerlendirilmesi için HAMD ölçeğipuanlarındaki değişim ve Klinik Global İzlenim (KGİ) Ölçeği puanları esas alınmıştır. Yorgunluk ve enerji azlığı belirtilerinin seyri Çok Boyutlu Yorgunluk Envanteri (MFI) ile, sosyal işlevlerin değerlendirilmesi ise Sosyal Uyum Öz-Değerlendirme Ölçeği (SASS) ile gerçekleştirilmiştir. Yan etkiler her bir değerlendirme görüşmesinde ayrıntılı olarak sorgulanmıştır. Bulgular: İzlem süresi boyunca araştırma grubunun ortalama HAMD puanlarında anlamlı bir azalma gözlenmiştir. HAMD puanında % 50 ve üzerinde bir düşüş tedaviye yanıt ölçütü olarak kabul edildiğinde, tedavi sonunda yanıt oranı % 67 olarak hesaplanmıştır. Remisyon ölçütü olarak HAMD toplam puanının 8 değerinin altında olması kuralı kabul edildiğinde, remisyon oranı % 60 olarak hesaplanmıştır. MFI puanlarının tedavi ile değişimi incelendiğinde, tedavi başlangıcına göre anlamlı bir düşme gözlenmiştir. SASS ölçeği puanlarında ise tedavi öncesine göre anlamlı bir artış gözlenmiştir. Tedavi süresince hastaların %88,6'sında en az bir yan etki görülmüş, %15.9'unda ise yan etkiler nedeniyle tedavinin kesilmesi gerekmiştir. Sonuçlar: Bu çalışma majör depresyon tedavisinde reboksetinin etkin ve güvenilir bir ilaç olduğunu göstermektedir. Aynı zamanda, depresyon hastalarında görülen sosyal işlevlerde bozukluk, motivasyon azlığı ve yorgunluk belirtileri üzerine reboksetinin olumlu etkileri olduğu kaydedilmiştir., Objective: The aim of the study was to investigate the efficacy, safety and tolerability ofreboxetine in major depressive disorder as well as its effect on energy, motivation and social functioning. Methods: This multicenter study was conducted as an open-label design. A total of 44 patients (10 male, 34 female) diagnosed with major depressive disorder according to DSM-IV, between the age of 18 - 65 were recruited in five different centers in Turkey. Inclusion of the study was dependent on an initial Hamilton Depression Rating Scale (HAMD) score of3 20 points at baseline. After an initial wash-out period, the patients were assigned to treatment with 8 mg/day ofreboxetine for 8 weeks. The dosage was increased to 10 mg/day at the investigator's discretion from week 4. The patients were re-evaluated at weeks 1, 2, 4, 6 and 8 to determine any changes in depressive symptoms and side effects. The efficacy analysis was done on the basis of the changes in scores of HAMD and Clinical Global Impression Scale (CGI). The general social functioning were measured by the Social Adaptation Self-Evaluation Scale (SASS). The energy and motivation level were assessed by the Multidimensional Fatigue Inventory (MFI). The frequency and severity of adverse events were also recorded during the study. Results: There was a significant reduction in the mean HAMD scores during the study period. When a decrease of at least 50 % in the HAMD total score from baseline was considered as an index of response, 67% of patients responded to reboxetine at the end of treatment period. When the remission was defined as having a HAMD total score £8, 60 % of patients were classed as being in remission at the end of the study. The SASS total score improved during the treatment period. Additionally, a significant decrease was detected on MFI scores at the end of the study. Overall, 88.6 % of patients have reported at least one adverse event and 15.9 % of patients discontinued treatment due to adverse events. Conclusion: The results from this study suggest that reboxetine is effective and safe in improving depressive symptoms as well as restoring energy, motivation and social functioning in patients with major depressive disorder.

Objective: For the onset of illness and possible recurrence during the childbearing period, women with bipolar disorder (BD) are at a higher risk. The aim of this study was to evaluate the impact of clinical and psychosocial factors associated with pregnancy and the postpartum period on the course of BD. Methods: The childbearing and illness history of 72 women with BD were assessed to determine mood episodes related to the childbearing period. Data was analyzed to evaluate the risk factors (clinical, obstetric and psychosocial factors) related with mood episodes during pregnancy and the postpartum period. Results: Data of 252 pregnancies and childbirths of 72 women with BD were included in the analysis. Twenty-three (32%) women with BD reported at least one mood episode during pregnancy or within 1 month after childbirth (childbearing-related episode, CBRE). Subjects with CBREs mean age at onset of illness and mean age at the time of assessment were significantly younger than subjects with N-CBRE. A lower number of women who experienced a postpartum episode after the birth of the first child chose to have the second one. Psychosocial factors during pregnancy and the postpartum period and method of delivery did not predict the first postpartum episode. Onset of illness at an early age, experiencing episode during the first pregnancy and experiencing physical problems during pregnancy predicted a mood episode during the first postpartum period. Conclusions: Interpretation of the results of the study is limited with the retrospective nature of data collection. Within the limitations, we may suggest that psychosocial factors do not play a significant role in the genesis of CBREs in women with BD.

Amaç: Bu çalışmada depresyonu olan genç kızlarla depresyonu olmayan genç kızlarda adet öncesi yakınmaların şiddetini ve profilini, ve ayrıca annelerdeki ve kızlarındaki adet öncesi duygusal, davranış ve fiziksel yakınma dalgalanmalarının ilişkisini araştırmak amaçlanmıştır. Yöntem: Hasta grubunu majör depresif bozukluk tanısı konmuş ve en az iki yıldır düzenli adet gören 15-18 yaşlan arasındaki 20 genç kız ve kontrol grubunu da hiçbir fiziksel ve ruhsal yakınması olmayan 17 genç kız oluşturmuştur. Adet öncesi duygusal, davranış ve fiziksel belirtilerini geriye dönük olarak sorgulayan Premenstrüel Değerlendirme Formu (PDF) ve depresyon belirtilerinin şiddetini belirlemek için de Beck Depresyon Envanteri (BDE) kullanılmıştır. Genç kızların ve annelerinin adet döngüsü bilgileri ve annelerin tıbbi ve ruhsal hastalık varlığı derlenmiştir. Bulgular: Araştırma ve kontrol grubunu oluşturan kızlar arasında sosyodemografik veriler açısından istatistiksel olarak anlamlı bir fark yoktur. Hasta grubunda daha fazla kız dismenoreden yakındığı ve daha fazla okula devamsızlık yaptığı halde iki grup arasında istatistiksel olarak anlamlı bir farklılık yoktur. Depresyon grubu genç kızlarla kontrol grubu genç kızlar arasında PDF toplam puanlannda ve PDF'nun bazı alt ölçeklerinde (depresyon ile ilişkili) istatistiksel olarak anlamlı farklılıklar bulunmuştur. Depresyon grubu genç kızlarla anneleri arasında PDF toplam puanlan ve bazı alt ölçekler arasında istatistiksel anlamlı farklılıklar gözlenirken kontrol grubu genç kızlar ile annelerinin PDF toplam puanlan ve alt ölçekleri arasında istatistiksel olarak anlamlı bir fark bulunmamıştır. Tartışma: Depresyonu olan ergenler prémenstruel dönemde daha fazla yakınmaları olduğunu belirtmişlerdir. Bu sonuç depresif ergenlerin daha fazla premenstrüel yakınma yaşadığı şeklinde yorumlanabilir. Ancak depresif bireylerin olumsuz bilişleri nedeniyle özbildirim ölçeğini doldururken olumsuz cümlelerden daha fazla etkilendiği bilinmektedir. Bu sonuçlarla depresyon tanılı bireylerde premenstrüel belirtilerin varlığını ve şiddetini belirlemek için geriye dönük ölçekler yerine ileriye dönük formlann kullanılmasının uygun olacağı söylenebilir., In this study, we aimed to compare the severity and profile of premenstrual complaints between depressed and non-depressed adolescent girls and make a correlation between mother's and daughter's premenstrual emotional, behavioral and physical complaints. Method: Twenty girls between age of 15-18 years who had met DSM-IV criteria for major depressive disorder and had regular menstrual cycle for at least two years were recruited. The control group included 17 volunteer high school female students who had no physical and mental illnesses. The Premenstrual Assessment Form (PAF) was used for the evaluation of the premenstrual emotional, behavioral, and physical symptoms. The Beck Depression Inventory (BDI) was used for the evaluation of the severity of depressive symptoms. The history of menstrual cycle and medical and mental disorders from the mothers were gathered. Result: There were no significant differences between depressed and nondepressed group on sociodemographic variables. Even though more depressed girls complained about dysmenorhea than normal controls, there were no statistical significant differences between two groups. There were statistically differences between depressed and non-depressed adolescent girls on variables of total PAF score, and subscales of PAF scores. There were no statistically differences between the control girls and their mothers on variables of the total PAF scores and subscales of PAF scores. Discussion: The adolescent girls who experienced emotional distress, such as depression, are likely to report the more change in emotional, behavioral and physical problems due to menstruation. The severity of depression is correlated with the severity of premenstrual problems. The results may suggest that depressed girls experience more premenstrual problems or because of their negative cognitions, they are influenced by the negative words/sentences in a self-report scale. We may suggest that the scales which are used to evaluate the premenstrual complaints of depressed subjects retrospectively do not show the correct severity of the premenstrual complaints.

Objective: The hypothesis of this study is that the efficacy of lamotrigine is related with blood level in bipolar disorder. Our aim is to compare the periods before and after lamotrigine use in cases with bipolar disorder and to investigate whether there has been any relation between lamotrigine blood level and clinical progress or not. Method: For this aim, 40 consecutive cases diagnosed with bipolar disorder type I according to DSM-IV criteria, using lamotrigine for at least two years in combination with any mood-stabilizing agent such as lithium, anticonvulsants or atypical antipsychotics have been evaluated. The cases who applied to our outpatients’ clinic for their routine controls and who additionally accepted to participate to the study and gave informed consent have been included in the study. For the evaluation, being in remission period was set as a criterion for these cases. The interview for confirming the bipolar diagnosis was carried out by using SCID-I. The sections before and after maintenance treatment present in the SKIP-TURK Mood Disorders Diagnosis and Patient Registration Form were filled in together with the patients and their relatives. Blood samples were collected from the cases in order to analyze lamotrigine blood level. Results: In bipolar cases, when the periods before and after long term maintenance treatment with lamotrigine were compared, it was determined that after using lamotrigine, total episode frequency and depressive episode frequency were decreased, episode severity was less severe (p, Amaç: Bu çalışmanın varsayımı, lamotrijinin, iki uçlu bozukluktaki etkinliğinin serum düzeyi ile ilişkili olduğudur. Amacımız, lamotrijin kullanan iki uçlu olgularda, lamotrijin öncesi ve sonrası dönemi karşılaştırmak, lamotrijin kan düzeyinin klinik gidiş ile bir ilişkisi olup olmadığını incelemektir. Yöntem: Bu amaçla lityum, antikonvulzan ya da atipik antipsikotik, herhangi bir duygudurum dengeleyici ile birlikte, en az 2 yıldır lamotrijin kullanan, DSM-IV’e göre, iki uçlu bozukluk tip I tanılı 40 olgu ardışık olarak değerlendirilmiştir. İki uçlu olgular ayaktan tedavi merkezimize olağan kontrolleri sırasında başvuran, çalışmaya katılmayı kabul ederek bilgilendirilmiş onam veren olgulardır. Bu olgularda değerlendirme için iyilik döneminde olma şartı aranmıştır. İki uçlu olgularla tanı görüşmesi SCID-I ile yapılmıştır. SKIP-TURK Duygudurum Bozuklukları Hasta Kayıt ve İzlem Formu’nda koruyucu sağaltım öncesi ve sonrasına ait bölümler, hasta ve hasta yakını ile birlikte doldurulmuştur. İki uçlu olgular lamotrijin kan düzeyi bakılmak üzere kan vermişlerdir. Bulgular: İki uçlu olgularda lamotrijinle uzun süreli sürdürümün öncesi ve sonrası karşılaştırıldığında, lamotrijin başlandıktan sonra, toplam atak sıklığı ve depresif atak sıklığının azaldığı, atak şiddetinin daha düşük olduğu (p