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Essential tremor (ET) is one of the most common movement disorders. Aside from tremor, patients may exhibit other motor features as well as non-motor features, including neuropsychiatric symptoms. The cerebellum and cerebellar connections are thought to play a key role in the pathophysiology of ET. Cognitive and affective disturbances can occur in the context of cerebellar disease. Our aim was to study the prevalence and clinical correlates of alexithymia and its relationship to depression and anxiety in ET patients and control subjects (CS).We enrolled 100 ET patients and 100 age- and gender-matched CS. The Toronto Alexithymia Scale-20 (TAS-20), the Beck depression inventory-II and the Beck anxiety inventory were administered.Alexithymia levels were significantly higher in ET patients than CS (respective mean TAS-20 scores = 50.63 ± 9.79 vs. 44.05 ± 12.51, p 0.001). There were robust associations between alexithymia, depressive symptoms, and anxiety but, after excluding the ET patients and the CS who had moderate or severe depression or who had moderate or severe anxiety, the total alexithymia score remained significantly higher in the ET than the CS group (46.78 ± 9.19 vs. 41.18 ± 11.79, p ≤ 0.01).This study suggests that prevalence of alexithymia is significantly higher in ET patients. Alexithymia might be another non-motor neuropsychiatric symptom of the disease. Further studies are needed to confirm and expand upon our findings.

Essential tremor (ET) is the most common movement disorder which has both motor and non-motor findings such as neuropsychiatic symptoms. Alexithymia is defined as inability to identify and describe emotions experienced by one's self or others. In our study, we aimed to evaluate the neurocognitive and brain micro-structural correlates of alexithymia in ET. 40 ET patients (mean age = 53.05 ± 19.74 years), were included. Fahn-Tolosa-Marin Tremor Rating Scale, Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Beck Anxiety Inventory and detailed neurocognitive evaluation were applied to all patients. The patients were divided into three groups based on their TAS scores: no alexithymia, probable alexithymia, definite alexithymia. Diffusion Tensor Imaging (DTI) was performed in all patients. The mean TAS score was 50.05 ± 10.06. Depressive symptoms and anxiety levels were higher in definite alexithymia (p < 0.001, p < 0.01). Partial correlation controlling for age, gender and educational level between alexithymia scores and each cognitive test showed significant association between similarities (p < 0.001) and phonemic verbal fluency (p = 0.04). Left orbitofrontal cortex average diffusion coefficient (ADC) value (p = 0.05), left anterior cingulate cortex fractional anisotropy (FA) value (p = 0.04), right cuneus FA value (p = 0.04), left amygdala ADC value (p = 0.01) and left insula ADC value (p = 0.02) were differed between groups. TAS and DTImetrics were not found to be independently associated with the level of anxiety (p < 0.001) and depressive symptoms (p < 0.01). As a conclusion, impairments in executive function and complex attention were correlated with higher levels of alexithymia in ET. Many micro-structural alterations were determined to be correlated with alexithymia levels.

Essential tremor (ET) is a complex, neurodegenerative disorder that includes motor and non-motor symptoms. There is growing interest in its non-motor features, including sleep disturbances (SD). There are no studies evaluating the brain structural correlates of SD in ET. We aimed to identify brain microstructural changes related to SD in ET. SD was evaluated using the Pittsburg sleep quality index (PSQI). Diffusion tensor imaging (DTI), with reported measures being fractional anisotropy (FA) and apparent diffusion coefficient (ADC), was used to evaluate microstructural brain changes. DTI data were compared in ET patients with vs. without SD. The mean age of 40 ET patients was 49.20 +/- 21.06 years. The mean PSQI score was 6.13 +/- 3.99, and 18 (45.0%) patients had SD. The mean PSQI score of patients with vs. without SD was 9.78 +/- 2.98 vs. 3.14 +/- 1.28 (p < 0.001). Patients with vs. without SD differed significantly with respect to several DTI findings: right (R) superior cerebellar peduncle ADC (p = 0.04), left (L) dorsolateral prefrontal cortex FA (p < 0.01), L frontooccipital fasciculus FA (p = 0.02), R posterior corona radiata (RPCR) FA (p = 0.01), L posterior corona radiata FA (p = 0.04), R posterior thalamic radiation (RPTR) FA (p = 0.02), and fornix FA (p = 0.03) Significant correlations between PSQI scores and RPCR FA (r = - 0.50, p = 0.02) and RPTR FA (r = - 0.67, p = 0.001) were also observed. Our findings suggest that certain brain changes may be associated with the clinical expression of SD in ET. These changes are discussed in terms of their possible neuroanatomical and physiological significance.

Objective:The purpose of this study was to examine obsessive and compulsive signs among patients with Restless Legs syndrome (RLS), to compare the results with healthy controls and to investigate clinic importance of those signs.Methods:Thirty nine patients with RLS and 40 age-, sex- and education- matched healthy controls were assessed in Bezmialem Foundation University Medical Faculty Hospital Neurology and Psychiatry Clinics Hospital. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV axis-1 disorders severe combined immune deficiency-1, socio-demographic data form and Maudsley obsessive compulsive inventory (MOCI) were applied to both patients and controls. Patient group was also classified according to the International RLS Study Group RLS severity scale.Results:Patient group had higher MOCI total scores and doubting and rumination subscale scores than the control group and the difference was statistically significant (p

Patients with epilepsy (PWE) might feel stigmatized due to the likelihood of having uncontrollable seizures and the possibility of their sudden occurrence in the community, which may lead to increased rates of social phobia in these patients. People with social phobia interpret others' attitudes toward them negatively and hence feel stigmatized. This vicious circle may be applied to PWE, reduces the quality of life and might cause them more challenging psychosocial problems than seizure management. We aimed to investigate the relationship between social phobia and stigmatization in PWE. Forty PWE and 40 age- and sex-matched healthy control subjects (HC) were included in the study. Liebowitz social anxiety scale (LSAS), Beck anxiety inventory (BAI), and Beck depression inventory (BDI)-II were administered to all participants. In addition to these, the stigma scale of epilepsy (SSE) was applied to the PWE, and the subcategory scores of this scale were calculated. The mean ages of the patient group and HC were determined to be 32.68 ± 10.67 and 33.80 ± 7.81, respectively (p>0.05). A significant difference was determined in the BDI-II, LSAS, and BAI scores of the patient group compared to HC (p

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson's disease (PD). Alexithy-mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com-mon pathology of neuroanatomical structures. We hypo-thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective - The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD.Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale-20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed.Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet-ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01).Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.A kognitív zavar a Parkinson-kór gyakori nem motoros tünete. Az alexithymia a Parkinson-kór még ma is kevéssé megértett neuropszichiátriai jellegzetessége. A kog­nitív zavar (különösen a visuospatialis és a végre­hajtó funkciók zavara) és az alexithymia hátterében ugyanazon neuroanatómiai struktúrák patológiája áll. Hipo­tézisünk szerint e neuroanatómiai kapcsolat követ­kez­tében összefüggésnek kell lennie a kognitív zavar és az alexithymia mértéke között. Cél – A vizsgálat célja az volt, hogy megvizsgáljuk, van-e összefüggés az alexithymia és a neurokognitív funkciók között Parkinson-betegek körében.A vizsgálatba 35 Parkinson-kóros beteget vontunk be. A Torontói Alexithymia Skálát (TAS-20), a Ge­riátriai depresszió-kérdôívet (GDI), valamint részletes neuropszichológiai vizsgálatokat alkalmaztunk.A magasabb TAS-20-pontszámok negatív összefüggésben álltak a Wechsler Intelligenciateszt felnôtt­változatának (WAIS) Similarities alskálájának pontszá­mai­val (r = –0,71; p-érték: 0,02), az órarajzolási teszt (CDT) pontszámaival (r = –0,72; p=0,02) és a verbális fluencia (VF) mértékével (r = –0,77; p0,01). Az érzelemazonosí­tási alskála pontszámai negatív összefüggésben álltak a CDT-pontszámokkal (r = –0,74; p=0,02), a VF-pontszá­mok­kal (r = –0,66; p=0,04), valamint a vizuális emléke­zet azonnali elôhívását mérô alksála pontszámaival (r = –0,74; p=0,01). A VF-pontszámok az érzelemleírás ne­héz­ségét mérô alskála (DDF) pontszámaival is összefüggést mutattak (r = –0,66; p=0,04). Fordított irányú összefüggés volt kimutatható a WAIS Similarities és a DDT alskálák pontszámai (r = –0,70; p=0,02), valamint a külsô orientáltságú gondolkodás alskála pontszámai (r = –0,77; p0,01) között. Összefüggés volt kimutatható a végrehajtó funkció Z alskála és a TAS-20-pontszámok középértéke (r = –62; p=0,03), valamint a DDF alskála pontszámai között (r = –0,70; p=0,01).Összefüggés volt kimutatható az alexi­thy­mia és a visuospatialis, valamint a végrehajtó funkciókat mérô tesztek eredménye között. Az alexithymia és a dep­resszív tünetek között szintén szignifikáns összefüggést találtunk. Az alexithymia megléte fel kell hívja a klinikus figyelmét a párhuzamosan fennálló kognitív zavarra.

Background Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. Objective To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. Method Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. Results Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. Conclusion These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.

Objective: Essential tremor (ET) is the most common cause of tremor. We know that this disease, which was presumed to be monosymptomatic until recently, may be accompanied by motor findings and a series of non-motor findings other than action tremor. Alexithymia can be defined as not being able to name emotions, express emotions, distinguish emotions from each other, or living without being aware of one’s own emotions. The aim of our study was to evaluate alexithymia in patients with ET. Materials and Methods: Forty-four patients with ET (mean age=38.22±18.05 years) and 46 control subjects (mean age=37.17±10.68 years) were included in the study. The Fahn-Tolosa-Marin Tremor Rating Scale was used for the patient group and the Toronto Alexithymia Scale (TAS), Beck Depression Inventory and Beck Anxiety Inventory were applied to both groups. Results: The mean TAS was 49.16±8.94 in the patient group and 42.34±6.27 in the control group (p

Migraine is a common and often debilitating disorder. Although the existence of a link between migraine and certain psychological features has long been known, data on dissociative experiences in migraine patients is insufficient. The aim of this study was to evaluate the presence of psychoform and somatoform dissociative experiences among migraine patients without aura and to examine their relationship with pain perception and disability.A total of 110 outpatients diagnosed with migraine based on the International Classification of Headache Disorders-III (ICHD-III) criteria and 70 healthy subjects were enrolled to this study. Sociodemographic data, Somatoform Dissociation Questionnaire (SDQ), Dissociative Experience Scale (DES), Beck Depression Inventory (BDI), and Beck Anxiety Scale (BAS) scores were recorded for each patient. The Migraine Impairment Disability Assessment Scale (MIDAS) and Visual Analog Scale (VAS) scores were also determined.The mean SDQ and DES scores were significantly higher in migraine patients (p0.001, p0.01). According to SDQ, somatoform dissociation disorder, dissociative disorder not otherwise specified, and dissociative identity disorder were considered in 29.4%, 18.3%, and 10.1% of the migraine patients, respectively. Also, 20.9% of the patients had possible psychoform dissociation according to DES. A significant positive correlation was found between DES, SDQ scores, and VAS, MIDAS scores. Patients were found to have statistically significantly higher levels of depression and anxiety symptoms compared to healthy controls (p 0.001). Higher DES and SDQ scores were associated with increased disability and pain level (p0.01).Our findings seem to confirm the increased occurrence of somatoform and psychoform dissociative experiences in migraine patients. This study was intended as a beginning towards understanding dissociative experiences in migraine.A migrén gyakori és rendszerint testi gyöngeséggel járó megbetegedés. Habár régóta ismert a migrén és egyes pszichológiai jellemzők közötti kapcsolat, nem rendelkezünk elég adattal a migrénben szenvedő betegek disszociatív élményeivel kapcsolatban. A vizsgálat célja az volt, hogy aurával nem rendelkező migrénbetegek körében felmérjük a pszichoform és szomatoform élmények jelentkezését, és megvizsgáljuk azok kapcsolatát a fájdalompercepcióval és a fizikai korlátozottsággal.A vizsgálatba 110 ambuláns migrénbeteget [diagnózisuk az International Classification of Headache Disorders-III (ICHD-III) alapján történt] és 70 egészséges kontrollszemélyt vontunk be. Rögzítettük a vizsgálati alanyok szociodemográfiai adatait, valamint a Szomatoform Disszociatív Kérdőívre (Somatoform Dissociation Questionnaire, SDQ), a Disszociatív Élmény Skálára (Dissociative Experience Scale, DES), a Beck-féle Depressziós Kérdőívre (Beck Depression Inventory, BDI) és a Beck-féle Szorongás Kérdőívre (Beck Anxiety Scale, BAS) adott válaszaikat. A vizsgálati alanyok kitöltötték a Migrén Korlátozottsági Kérdőívet (Migraine Impairment Disability Assessment Scale/MIDAS) és meghatároztuk Vizuál-analóg Skála (VAS) -pontszámukat is.Az SDQ- és a DES-pontszámok középértéke szignifikánsan magasabb volt a migrénbetegek körében (p0,001, p0,01). Az SDQ-pontszámok alapján szomatoform disszociációs zavar a migrénbetegek 29,4%-a esetében jelentkezett, míg nem specifikus disszociációs zavar 18,3%-uk, disszociatív személyiségzavar 10,1%-uk esetében. A DES-pontszámok alapján a betegek 20,9%-a esetében állhatott fenn pszichoform disszociáció. Szignifikáns pozitív korrelációt találtunk a DES- és SDQ-pontszámok, valamint a VAS- és MIDAS-pontszámok között. A kontrollszemélyekkel összehasonlítva, a migrénbetegek körében szignifikánsan ma­gasabb volt a depresszió és a szorongás szintje (p0,001). A magasabb SDQ- és DES-pontszámok megnövekedett fizikai korlátozottsággal és fokozottabb fájdalompercepcióval jártak együtt (p0,01).Eredményeink azt igazolják, hogy migrénbetegek körében megnövekszik a szomatoform és pszichoform disszociációs zavarok előfordulása. A szerzők szándéka további vizsgálatokat folytatni a migrénhez társuló disszociatív élmények megértése érdekében.

Introduction: This study aims to compare sociodemographic characteristics of the patients with bipolar disorder (BD) with and without comorbid dissociative disorder (DD) and to investigate the eventual effect of the comorbidity on the treatment.Methods: We enrolled a total of 149 patients diagnosed with BD and treated as inpatients consecutively in Şişli Etfal Hospital, Psychiatry Clinic between 2010 and 2011. For the patients who were diagnosed with DD using SCID-D and with BD using SCID-I, sociodemographic characteristics, YMRS, HAM-D, BPRS, DES scores and duration and number of hospital stays were evaluated.Results: 23 patients (15.4%) had dissociative disorder not otherwise specified (DD-NOS), 4 patients (2.6%) had dissociative identity disorder (DID) and 1 patient (0.6%) had dissociative amnesia. BD patients with comorbid DD were found to be predominantly female (p=0.015) and younger (p=0.002) and to have significantly higher DES scores than BD patients without DD (p

Onur Yilmaz,1 Yildizhan Şengül,2 Hakan Serdar Şengül,3 Fatma Büşra Parlakkaya,1 Ahmet Öztürk1 1Bezmialem Foundation University Medical Faculty, Department of Psychiatry, Istanbul, Turkey; 2Bezmialem Foundation University Medical Faculty, Department of Neurology, IIstanbul, Turkey; 3Gaziosmanpasa Taksim Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey Purpose: The purpose of this study was to examine alexithymia among restless legs syndrome (RLS) patients, compare with healthy controls, and argue the clinical inferences of this relationship. We searched for anxiety and depression and their clinical outcomes among patients and searched whether the results are similar to previous studies. Patients and methods: Eighty-seven RLS patients and 88 age, gender, and educationally matched healthy controls were assessed in Bezmialem Foundation University Hospital. RLS patients and healthy controls were assessed with the Sociodemographic Data Form constructed for the present study, 20-item Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory (BDI), and Beck Anxiety Scale (BAS). The patient group was also assessed with the International Restless Legs Syndrome Study Group (IRLSSG) RLS Severity Scale. Results: RLS patients were found to have greater TAS-20, BDI, and BAS scores compared with the control group (P < 0.05). RLS severity score was positively correlated with the scores of anxiety and depression scales. However, no significant relationship was found between scores of IRLSSG RLS scale and TAS-20 total and subscale scores. Conclusion: RLS patients were found to be more alexithymic than healthy controls, whereas no significant relationship was found between RLS severity and levels of alexithymia. Still, alexithymia might be a predictor for early diagnosis and may be considered in the treatment and follow-up of RLS. RLS patients have higher depression and anxiety scores than healthy individuals. Thus, depression and anxiety should be taken into consideration throughout the RLS treatment. Keywords: restless legs syndrome, alexithymia, anxiety, depression

Essential tremor (ET) is the most common movement disorder and cause of functional disability. ET is known as a monosymptomatic, pure motor system disease. This interpretation of ET has been questioned in the last decade. Non-motor symptoms have added to the definition of the disease. In autopsy studies, it has been reported that Lewy bodies are common in the locus coeruleus, which is known to have an active role in sleep. Previous research about sleep in ET has studied older patients. Sleep disturbances are common in older adults. Our study focused on younger patients who had the disease for a shorter period of time. 40 patients (24.9 ± 7.0 years old) and 28 controls were recruited for the study. Sleep quality was evaluated with the Pittsburg Sleep Quality Index (PSQI). Excessive daytime sleepiness (EDS) was evaluated with the Epworth Sleepiness Scale (ESS). For assessing the possible impact of depression and anxiety on sleep we used the Beck Depression Inventory (BDI), and the Beck Anxiety Scale (BAS). We ruled out other possible causes of tremor. Tremor was evaluated using the Fahn Tolosa Marin Tremor Rating Scale (FTM-TRS). We concluded that although ET patients had bad sleep quality, this might be associated with increased anxiety levels. Mean ESS scores were higher in the patient group, but this was not statistically significant.

Many studies have investigated the association between headache and sleep disorders, but few have focused on migraine. The goal of this study was to evaluate sleep disturbance and excessive daytime sleepiness (EDS) in relation to migraine disability. 120 migraine patients who were diagnosed according to The International Classification of Headache Disorders-II and 45 healthy controls were recruited for the study. All participants completed the Pittsburg Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, Beck Depression Inventory and Beck Anxiety Scale. Migraineurs completed Migraine Disability Assessment Scale (MIDAS) and Visual Analog Scale. The prevalence of poor sleep was 83.3% in the patients and 22.2% in the controls. All PSQI subgroup scores were higher for the patients than the controls except “Hours asleep”. EDS was more prominent in the patient group (19.2% vs 2.2%). In conclusion, sleep disturbance, EDS, anxiety, and depressive symptoms were detected more commonly in migraine patients and were correlated with the migraine-related disability. The results of multivariate regression analysis indicated that EDS and sleep disturbance were the most effective factors on disability.

Objective: In multiple sclerosis (MS); memory, attention, information processing speed, and executive function deficits associated with cortical demyelination and atrophy can be seen in the early phases. In essential tremor (ET) cognitive impairment associated with cerebral-thalamocortical pathway dysfunction, which is characterized by visuospatial functions, verbal memory, and executive functions were seen. We aimed to evaluate cognitive impairment in patients with MS and ET, and to compare the features of impairment. Materials and Methods: Thirty patients ET (mean age 27.7±6.8 years), 30 patients with MS (mean age 32.4±6.6 years) and 20 healthy controls (mean age 28.81±7.3 years) were recruited for the study. For assessing cognitive impairment, the Montreal Cognitive Assessment (MoCA) test was applied to all participants. For grading the disease, the Fahn-Tolosa-Marin Tremor Rating Scale was used in the ET group, and the Expanded Disability Status Scale was used in the MS group. Results: The total MoCA mean scores in patients with MS was 22.4±4.34, 25.8±2.7 in patients with ET, and 28.2±1.8 in controls. When we compared the patients with the controls, the patients’ mean score was lower than in the controls. Cognitive impairment in patients with MS was more apparent than in patients with ET. Naming, attention, language, and delayed recall subgroups in patients with MS were more affected than in patients with ET. Conclusion: In this present study, we determined cognitive impairment can be seen in both group of patients, and MS can cause more prominent deficit than ET. In addition, our study confirms that cognitive impairment in MS and ET can be detected using the MoCA test.

In the last decade our perspective on essential tremor (ET) as a pure motor system disorder has begun to change. By virtue of recent studies of nonmotor symptoms (NMSs) that are used to characterize Parkinson’s disease (PD), these symptoms have also been added to the definition of ET. There is increasing evidence to suggest that ET might not be as benign and monosymptomatic as we previously thought. The aim of this study was to evaluate nonmotor symptoms in ET, and to compare them with PD. We studied 37 ET and 23 PD patients. Tremor rate was evaluated using the Fahn–Tolosa–Marin tremor rating scale (FTM-TRS) in ET patients. The patients with PD were scored for motor symptoms using the unified Parkinson’s disease rating scale (UPDRS)-III and the Hoehn–Yahr scale. Cognitive functions were assessed with the Montreal Cognitive Assessment (MoCA) test. NMSs were evaluated with the nonmotor symptoms questionnaire (NMSQuest). In the ET group, the most common NMSs were forgetting things, feeling sad, nocturia, urgency, and difficulty concentrating. The mean NMSQuest score was 8.43 ± 4.14 in the ET group and 14.06 ± 5.44 in the PD group (p value

An arachnoid cyst is a benign, space-occupying lesion which contains cerebrospinal fluid. Clinical manifestations may vary according to the size of the cyst and the interaction between the surrounding neuronal structures. Mental disorders rarely accompany the clinical picture and most of the cases remain symptom-free unless determined by radiological examinations accidentally. Although there are some cases reported on the comorbidity of psychosis and arachnoid cysts, no case has been reported on the comorbidity of bipolar disorder and arachnoid cysts so far. In this case report, a male patient with bipolar disorder and an arachnoid cyst in occipital lobe located in posterior fossa is presented and discussed in light of literature.

The literature about manic reactions as side effects of antimicrobial agents is restricted to a limited number of case reports. We here present a secondary mania case due to antibiotic use with a positive family history for mood disorders. We report the case of a 16-year-old patient developed an acute manic psychosis after 1 week administration of amoxicillin. Patient was treated with lithium and risperidone. In the first week of the treatment with mood stabilizer and an antipsychotic patient’s Brief Psychiatric Rating Scale and Young Mania Rating Scores decreased and patient was discharged. Antibiotic agents may trigger a mood disorder in individuals with a positive family history and discontinuation of the antibiotic agent may not be enough to alleviate the symptoms. Mood stabilizers and other antimanic agents are frequently needed.