Search

Corresponding author: Steven Sam, steven.sam@brunel.ac.uk Introduction: This project explores the potential of digital health technologies, including wearable Internet of Things (IoT) solutions, to remotely monitor and capture parameters and data for detecting and improving communications in accessing health care. The main aim is to facilitate the prevention of various health conditions (e.g., preterm, tetanus, fevers, measles and diarrhoea) in infants in Sierra Leone that lead to high infant mortality rates in Sierra Leone. Sierra Leone has one of the highest infant mortality rates, estimated at 39 per 1000 live births – three times higher than the Sustainable Development Goal (SDG) target of 12 infant deaths per 1000 live births by 2030. Lack of access to and low utilisation of effective and efficient health systems, aggravated by a range of factors, such as inequity in coverage, inadequate human resources and weak infrastructure, referral information and community health systems, are major contributing factors for high infant deaths. The solutions will assist in addressing these challenges. Objectives: The project aims to assist efforts to reduce infant deaths through developing culturally appropriate, people-led design of digital health technologies, including mobile and wearable IoT solutions to: (i) facilitate remote monitoring of infant health (vital signs such as temperature, pulse rates, respiration blood pressure, etc.) and alerting of potential critical illness in non-clinical settings, and (ii) improve healthcare access and ethical and FAIR data sharing between parents and health workers in Sierra Leone. Methods: The overall research approach is informed by a participatory design thinking framework, with the emphasis on four fundamental principles critical for developing appropriate and contextualised digital technologies in resource-poor settings: availability, accessibility, affordability and usability. It adopts a mix of socio-technical research using literature review and interviews and a co-design workshop with healthcare providers and caregivers. The socio-technical research provides in-depth insights into the contextual issues around the current healthcare system, challenges and opportunities for new technology innovations. The design workshop embodied inputs from the socio-technical research, participants’ experiences, design scenarios, image-based reflections, journey maps and group discussions. Results: Timing is everything to reduce child deaths. Both healthcare workers and caregivers believe that acting as soon as the first symptoms are detected can make a significant difference in reducing the risk of infant deaths. Therefore, the remote monitoring solutions should provide early alerting for symptoms of common child illnesses such as malaria, pneumonia and diarrhoea, to facilitate informed decision making, timely response and treatment. Results further show a layered deployment of remote monitoring technology ecosystem including a paired wearable design used both on infants and primary carers, a mobile application and community/mobile internet kiosk to facilitate communication among different stakeholders, which, at times, may not even share a common spoken language. This layered approach is also expected to facilitate technology adoption in phases. Conclusion: Our research confirms that digital technologies solutions designed together with the actual users can address contextually relevant healthcare solutions that reflect their actual needs. The layered deployment ecosystem emerged as a potential solution to strengthen information sharing and timely decision making and provide effective routes for remote monitoring and early alerting and access to the treatment of leading causes of infants’ deaths in Sierra Leone. Engineering and Physical Sciences Research Council ref: EP/S032045/1 (SMILE - System for Monitoring Infants in Low-Resource Environments).

Objective: Nicotine addiction is the most prevalent addiction type all over the world and attention deficit hyperactivity disorder (ADHD) is an important factor associated with nicotine addiction. Primary aim of this study was to evaluate the effect of ADHD symptoms on smoking cessation. Methods: Smokers who had admitted to the smoking cessation center were evaluated with using Wender Utah and Fagerstorm Scales at the beginning of study and for the success of smoking cessation at the end of 6 months. Results: Of the 353 smokers enrolled to the study, 99 individuals had a score of 36 or higher on Wender Utah scale (ADHD symptoms group). Of these 99 patients with ADHD symptoms, 11 (11.1%) and of the 254 non-ADHD symptoms group, 68 (26.8%) had quitted smoking after a period of six months. Logistic regression analysis revealed that having ADHD symptoms predicted failure of smoking cessation (adjusted odds ratios 2.12, 95% confidence interval 1.02-4.40) after controlling for sociodemographic and smoking-related variables. Conclusions: ADHD symptoms may be an important factor affecting smoking cessation. Examining these symptoms in problematic nicotine addicts might help treatment outcome.

On the basis of two experiments on comprehension, it is argued that children go through at least three stages in acquiring the deictic contrasts between "here and there," and between "this and that." Children follow different routes through these states, since they choose different starting points in mastering deitic contrasts. (EJS)

We present results of a dark matter search performed with a 0.6 kg day exposure of the DAMIC experiment at the SNOLAB underground laboratory. We measure the energy spectrum of ionization events in the bulk silicon of charge-coupled devices down to a signal of 60 eV electron equivalent. The data are consistent with radiogenic backgrounds, and constraints on the spin-independent WIMP-nucleon elastic-scattering cross section are accordingly placed. A region of parameter space relevant to the potential signal from the CDMS-II Si experiment is excluded using the same target for the first time. This result obtained with a limited exposure demonstrates the potential to explore the low-mass WIMP region (, 11 pages, 11 figures

OBJECTIVE: Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years' observation with acute and maintenance ECT in a university hospital in Turkey. METHODS: The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. RESULTS: A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. CONCLUSION: The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs.

Objective: Alcoholism is associated with genetic variants of genes related to alcohol metabolizing enzymes, dopaminergic, gamma-aminobutyric acidergic, glutamatergic, opioid, cholinergic, and serotonergic systems. Neurpeptide Y system and Neurexins were shown to be associated with alcohol dependence. Recent studies identified new genetic polymorphisms related to endogenous cannabinoid system, neuropetide Y and neurexin. In the present study, we aimed to investigate the association of Neurpeptide Y LEU7PRO rs16139 and neurexin 3 gene rs760288 polymorphisms with alcohol dependence in patients with alcohol dependence and healthy control subjects. Methods: 123 patients who were diagnosed with alcohol dependence according to the DSM-IV criteria and 159 healthy volunteers were included in the study. Blood samples were used to investigate polymorphisms. The genotyping of the neurexin 3 gene rs760288 and the neuropetide Y gene Leu7Pro rs16139 polymorphisms was performed using TaqMan SNP Genotyping Assays Real-Time PCR System. Results: Of the 2 genetic polymorphisms investigated in the present study, we detected association between and neurexin 3 gene rs760288 polymorphisms with alcohol dependence. Conclusions: Neurexin gene polymorphisms might be an important factor in development of alcohol addiction.

Objective: Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years' observation with acute and maintenance ECT in a university hospital in Turkey. Methods: The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results: A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion: The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT Should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs.

…

Western Turkey's extension-related Cumaovasi volcanic rocks (Lower Miocene, 17 Ma) are excellent examples of silicic eruptions. The sub-aerial silicic volcanism at Cubukludag Graben between. Izmir and Kusadasi in west-central Anatolia is mainly in the form of rhyolite domes, lava flows and pyroclastic deposits. The initial features of volcanism derived from phreatomagmatic explosive eruptions from silicic magma that came into contact with lake waters during Neogene times. Most of the volcanic succession represents pyroclastic density currents (PDCs), known as the Kuner ignimbrite. The deposits are fine grained and laminated at the base and pass laterally and vertically into deposits displaying well-developed traction structures, soft sediment deformation and/or erosion channels in the NE part of the region. Alternate deposits of massive, diffusely stratified lapilli and ash are the main products of the later explosive stage. Massive lithic breccias forming the top of the sequences are the proximal facies of the PDCs. The lava phase mainly consists of rhyolite extruded as dome and fissure eruptions of lavas, aligned along NE-SW-trending faults as well as from extensional cracks that are nearly perpendicular to the main graben faults. Considering the tectono-stratigraphical aspects and geochemical nature of the study area, we propose that the Cumaovasi silicic volcanism was produced by extension-related crustal melting during the Late-Early Miocene period (17 Ma).

Objective The synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters. Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD). We investigated whether these SNAP-25 polymorphisms (Mnll T/G and Ddell T/C) were also associated with ADHD in the Turkish population. Methods Our study comprised unrelated 139 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. Results SNAP-25 Ddell polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 Mnll polymorphism. For SNAP-25 Mnll polymorphism patients with G/G genotype of the SNAP-25 gene Mnll polymorphism had higher Wender-Utah scores and higher scores in the 1st and 3rd parts of adult ADD/ADHD Scale. Conclusion We detected a significant association of the Mnll polymorphism in our ADHD sample which was similar to previous findings. Our study also revealed that SNAP-25 Mnll polymorphism was also associated with symptom severity of ADHD. This study is also, the first report on the association of SNAP-25 with ADHD in the Turkish population.

Objective: The rate of polypharmacy is increasing in patients with psychotic disorders. Polypharmacy is defined as the concomitant use of two or more drugs at a time. As most psychotropic medications are metabolized via the cytochrome enzyme system, it is easy to predict that polypharmacy will increase the risk of drug-drug interactions. This study was planned to evaluate the interaction risks of medications used by patients with a diagnosis of schizophrenia and schizoaffective disorder. Method: This study enrolled inpatients and outpatients of 18-65 years of age, diagnosed with schizophrenia or schizoaffective disorder according to the DSM-IV classification, who had been receiving antipsychotics for at least 12 weeks. Co-administration of antipsychotic and other psychotropic drugs for at least 4 weeks was recorded as polypharmacy.The risk of interaction was determined as follows: all medications one patient was using were sent to the internet site https://drugs.com as individual treatment regimens, and interaction information for healthcare specialists was used. Results: The study sample consisted of 240 patients (141 males; 58.8%; 99 females; 41.2%) in total, with the schizophrenia spectrum of diseases (schizophrenia, schizoaffective disorder). One hundred and thirty six (56.6%) patients used only one antipsychotic and 104 (43.4%) patients used 2 or more antipsychotics. The mean number of medications was 2.58 +/- 1.22 (min 1-max 6), the mean number of interactions was 1.90 +/- 2.04 (min 1-max 10). One hundred and seventy two (71.7%) patients were taking medications with a risk of interaction, with 417 total drug interaction risks. Of the interaction risks, 87.8% (total number 366) were at a moderate level. Approximately one quarter of the patients (n=42, 24.4%) were using medications with a major risk, and two patients (1.2%) were taking drugs with a minor risk of interaction. Among probable outcomes of drug interactions, the first 3 places were occupied by a risk of anticholinergic side effects, a risk of CNS or respiratory depression and a risk of QT prolongation. Conclusion: The present study reports that an important percentage of patients are exposed to drug-drug interactions with ever-increasing use of multiple medications in the schizophrenia spectrum of diseases, and among these interactions, most major risks were cardiovascular risks, especially QT prolongation. Prospective studies with larger numbers of patients are needed in this area.

Background: SNAP-25 protein is contributory to plasma membrane and synaptic vesicle fusions that are critical points in neurotransmission. SNAP-25 gene is associated with behavioral symptoms, personality and psychological disorders. In addition, SNAP-25 protein can be related to different neurotransmitter functions due to its association with vesicle membrane transition and fusion. This is important because neurologic, cognitive, and psychologic disorders in fibromyalgia syndrome (FMS) can be related to this function. This relationship may be enlightening for etiopathogenesis of FMS and treatment approaches. We aimed to study a SNAP-25 gene polymorphism, which is related to many psychiatric diseases, and FMS association in this prospective study. Methods: We included 71 patients who were diagnosed according to new criteria and 57 matched healthy women in this study. Both groups were evaluated regarding age, height, weight, BMI, education level, marital and occupational status. A new diagnosis of FMS was made from criteria scoring, SF-36, Beck depression scale, and VAS that were applied to the patient group. SNAP-25 gene polymorphism and disease activity score correlations were compared. Results: Mean age was 38 +/- 5,196 and 38.12 +/- 4.939 in patient and control groups, respectively (p=0.542). No significant difference was found between groups regarding age, height, weight, BMI, education level, marital or occupational status (p > 0.05). Ddel T/C genotype was significantly higher in the patient group (p = 0.009). MnlI gene polymorphism did not show a correlation with any score whereas a significant correlation was found between Ddel T/C genotype and Beck depression scale and VAS score (p < 0.05). Conclusion: FMS etiopathogenesis is not clearly known. Numerous neurologic, cognitive and psychological disorders were found during studies looking at cause. Our study showed increased SNAP-25 Ddel T/C genotype in FMS patients compared to the control group, which is related to behavioral symptoms, personality and psychological disorders in FMS patients.

Objective: Alcohol dependence is associated with genetic variants of alcohol-metabolizing enzymes and genes related to dopaminergic, gamma-aminobutyric acidergic, glutamatergic, opioid, cholinergic, and serotonergic systems. Genetic variations in the endogenous cannabinoid system are also involved in alcohol dependence. The present study aimed to evaluate the association between three polymorphisms, DRD2 TaqIA, 5-HT1B A-161T and CNR1 1359 G/A (rs1049353), and alcohol dependence. Methods: One hundred twenty three patients, who were diagnosed as having alcohol dependence according to the DSM-IV criteria and 125 healthy volunteers, were included in the study. With written informed consent, a blood sample was drawn from each individual. Venous blood samples were collected in ethylenediaminetetra acetic acid (EDTA) containing tubes. DNA was extracted from whole blood by the salting out procedure. Genetic analyses were performed as described in the literature by using a Polymerase Chain Reaction method. SPS5 17.0 software was used for statistical analysis. Results: The DRD2 TaglA polymorphism was analyzed in the study and control groups. In the study group, the All A1 genotype was observed in 5 (4.0%) patients, the A1/A2 genotype was observed in 51 (41.5%) patients and the A2/A2 genotype was observed in 67 (54.5%) patients. In the control group, the A1/A1 genotype was observed in 6 (4.8%) subjects, the A1/A2 genotype was observed in 40 (32.0%) subjects and the A2/A2 genotype was observed in 79 (62.2%) subjects. For the 5-HT1B receptor A-161T gene polymorphism, the A/A genotype was detected in 61(49.6%) patients, the Ail genotype was detected in 53 (43.1%) and the T/T genotype was detected in 9 (7.3%) patients. In the control group, the A/A genotype was detected in 84 (67.2%) subjects, the All genotype was detected in 39 (31.2%) subjects, and the T/T genotype was detected only in 2 (1.6%) subjects. The G/G genotype was the most common genotype in both study and control groups for CNR1 1359 gene polymorphism. It was detected in 75 (61.0%) study patients and in 84 (67.2%) control subjects. The G/A genotype was observed in 39 (31.7%) patients of the study group and 38 (30.4%) subjects of the control group. The A/A genotype was the most rare genotype in both groups; it was detected only in 9 (7.3%) study patients and 3 (2.4%) control subjects. Of the three polymorphisms investigated, 5-HT1B A-1 61T was the only one found to be associated with alcohol dependence. Conclusions: The 5-HT1B receptor A-161T polymorphism might be a promising marker for alcohol dependence

Objective This study is designed to investigate the factors affecting parental anxiety regarding their children with head injury in the emergency department (ED). Materials and methods This prospective observational study enrolled all consecutive paediatric patients admitted to the university-based ED with the presenting chief complaint of paediatric blunt head injury (PBHI). The parents were asked to respond to the 10-item questionnaire during both presentation and discharge. Anxiety and persuasion scores of the parents were calculated and magnitudes of the decreases in anxiety and persuasion scores were analysed with respect to sociodemographic and clinical variables. Results The study sample included 341 patients admitted to the ED. The anxiety and persuasion scores of mothers and fathers were not significantly different from each other on presentation while the extent of decrease in anxiety scores of mothers were significantly smaller than that of the fathers (p=0.003). The parents' education levels had significant impact on anxiety and persuasion scores recorded on presentation. The anxiety and persuasion scores were inversely related to education levels of the parents on presentation (p=0.002 and p=0.000, respectively). In addition, lower education levels were found to be associated with a greater decrease in anxiety and persuasion scores. Neurosurgical consultation also affected the magnitude of the decrease in anxiety and persuasion scores of the parents. The changes in the scores were affected negatively by the parents' age. Conclusions Radiological investigations had no significant impact on the decrease in anxiety and persuasion scores of the parents by themselves, while neurosurgical consultation had significant impact on them. Emergency physicians should tailor their strategy to institute effective communication with the parents of children to cut down unnecessary investigations in PBHI.

Objective: The relationship between menstruation disorders and antidepressant drugs usage in women remains unclear. In this study, we aimed to investigate the incidence rate of antidepressant-related menstruation disorders and to examine whether or not antidepressant use is associated with menstrual disorders in women. Methods: The study sample was gathered from three centers and four hospitals. A total of 1432 women who met the criteria of inclusion were included in the study. The sample was divided into two groups: the antidepressant group (n=793) and the control group (n=639). The menstruation disorders were established with reports from the study participants on the basis of related gynecological descriptions. Results: The prevalence of menstrual disorders was significantly higher in the antidepressant group (24.6%) than the control group (12.2%). The incidence of antidepressant-induced menstruation disorder was 14.5%. The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline and their combination with mirtazapine. Overall, the incidence rate was similar in women receiving selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors. Conclusions: The results of the present study suggest that menstruation disorders are frequently observed in women taking antidepressants and that it appears to be associated with antidepressant use at least in some women. (C) 2012 Elsevier Inc. All rights reserved.

Objective: Carbohydrate-Deficient Transferrin (CDT) is a biomarker, which is more specific and sensitive than the traditional markers for screening alcohol-use disorders and is approved by the U.S. Food and Drug Administration (FDA). We aimed to evaluate the correlation between CDT and severity of alcohol withdrawal and to compare CDT with other markers such as gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV Methods: A total of 48 male subjects were enrolled in the study. The patients were evaluated with socio-demographic data form and the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-AR). CDT, GGT and MCV values were measured at admission to the hospital. SPSS version 13.0 was used for evaluation of data. Results: CDT, GGT and MCV values were found to be high in 77.1%, 72% and 66.6% of patients, respectively. There was a statistically significant correlation between CDT and CIWA-AR scores, but there was no correlation of CIWA-AR with GGT and MCV. Conclusion: The individuals with high CDT values might be regarded as having a more serious withdrawal syndrome. However, controlled studies with larger number of subjects are needed to further analyze these results. (Archives of Neuropsychiatry 2011; 48: 184-7)

Malingering and Munchausen Syndrome (a subgroup of factitious disorder) were difficult conditions for emergency physicians to deal with. Munchausen Syndrome was characterized with intentional production or feigning of physical or psychological signs or symptoms. Malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation, avoiding punishment or obligations like school, work or military service. In this report we presented a case of malingering, who fabricated symptoms of severe pain for obtaining opiates from emergency department.

Objective: Attention deficit hyperactivity disorder (ADHD) is a developmental disorder which is characterized by inattention, impulsiveness, and hyperactivity. The etiology of ADHD is not completely understood, but it is well known that the disorder has a moderate to high genetic component, with an estimated heritability of 76%. Polymorphic variants in several genes involved in regulation of the dopamine and related neurotransmitter pathways have been reported to be associated with ADHD. In this research we aimed to investigate the relationship between adult ADHD and DAT1 (dopamine transporter), DRD4 (dopamine D4 receptor), DRD3 (dopamine D3 receptor) gene polymorphisms. Method: Our study comprised unrelated 79 subjects who met DSM-IV criteria for adult ADHD and 75 controls and all were living in Denizli. All of the patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. With written informed consent, a blood sample was drawn from each subject individual. Venous blood samples were collected in ethylene diamine tetra acetic acid (EDTA) containing tubes. DNA was extracted from whole blood and genetic analyses were performed as described in the literature by using Polymerase Chain Reaction method. SSPSS 15.0 for Windows was used for statistical analyses. Results: Twenty-three of ADHD patients were defined as predominantly inattentive type, 22 of ADHD patients were defined as predominantly hyperactive-impulsive, and the rest of them were defined as combined type ADHD. 10/10 and 9/10 repeats were most relevant genotypes in both study and control group for DAT1 VNTR (variable number of tandem repeat) polymorphism. 4/4 and 4/7 repeats were mostly found in both study and control groups for DRD47- repeat allele gene polymorphism. Ser/Ser polymorphism was the most relevant genotype in both study and control group for DRD3 Ser9Gly gene polymorphism. DAT1 VNTR, DRD3 Ser9Gly, and DRD4 7- repeat allele gene polymorphisms were not associated with ADHD. These gene polymorphisms were also not associated with subtypes of ADHD. Conclusions: We couldn't detect any association between DAT1 VNTR, DRD3 Ser9Gly, and DRD4 7- repeat allele gene polymorphisms and adult ADHD. Ethnicity and sample size are important factors at case control type genetic studies. European studies mostly reported an association between polymorphism of these genes and ADHD, but majority of Middle Eastern and Asian studies didn't report such an association between these genes and ADHD. Multi centered future studies using genome wide scan and variable tandem repeat techniques with larger samples would be helpful for understanding the role of dopaminergic system at ADHD genetics.

Objective: Although attention-deficit hyperactivity disorder (ADHD) was perceived as a disorder of childhood, it is now recognized as a chronic condition persisting into adulthood. The aim of this study was to explore the frequency of comorbidity in adults with ADHD. Methods: 80 ADHD patients between 16 and 60 years of age and 80 controls were recruited to the study. The groups were compared in terms of socio-demographic characteristics and diagnosis based on SCID-I and SCID-II. Results: The groups were identical regarding socio-demographic characteristics such as age, gender, education and marital status. The frequency of generalized anxiety disorder, major depression, dysthymia, somatoform disorder, antisocial and borderline personality disorders was significantly higher in ADHD group compared to the control group. Conclusion: We found that adult ADHD was an important risk factor for psychiatric comorbidity throughout lifetime. It is clear that misdiagnosis of comorbid disorders in ADHD patients may cause worsening of the symptoms and treatment resistance. Further studies on this topic may help us to better understand the course of adult ADHD and its treatment. (Archives of Neuropsychiatry 2010; 47: 139-43)

Objective: Antipsychotic induced weight gain is a major problem for second generation antipsychotics which may lead to diabetes and metabolic syndrome. Recent studies were mentioning that genetic factors might be relevant in antipsychotic induced weight gain. Aim of this study is evaluation of the association between IRS-1 Glyp972Arg polymorphism and olanzapine induced weight gain. Methods: Total of 95 patients whom were diagnosed as schizophrenia by DSM-IV criteria were included to study. Body weight, body mass index and blood glucose levels of all patients were checked at the beginning and six weeks after olanzapine treatment. Blood for DNA analysis were obtained from patients and analyzed as mentioned in literature. Data were evaluated with descriptive methods and Mann Whitney U test was used for comparison of two groups. Results: Eighty and four of patients had Glycine/Glycine and 11 patients had Glycine/Arginine genotype of IRS-1 Gly972Arg polymorphism. Despite the patients with Glycine/Glycine polymorphism gained more weight than patients with Glycine/Arginine polymorphism, the difference between Glycine/Glycine and Glycine/Arginine groups for weight change and body mass index change wasn't statistically significant. Conclusion: Our results showed no statistical relationship between the IRS-1 Gly972Arg polymorphism and olanzapine induced weight gain. However exploration of the other IRS genotypes and the antipsychotic-induced body weight change may help in the understanding of the mechanisms of antipsychotic-induced body weight gain. (Anatolian Journal of Psychiatry 2010; 11:18-22)

Maintenance electroconvulsive therapy is used for refractory bipolar disorder. We present a middle-aged man with refractory bipolar disorder who was successfully treated with maintenance electroconvulsive therapy and long-acting risperidone.

Aim: The aim of the present study was to investigate the differences in the antioxidant-oxidant balance (AO-OB) between schizophrenic patients and healthy individuals and to explore the relationship of AO-OB with illness subtypes and symptom profiles. Methods: After a 15-day drug-free period, schizophrenia patients (n = 50) in a clinical sample, and age- and sex-matched healthy subjects (n = 49) were enrolled. Total antioxidant potentials (TAOP) and total peroxide levels (TPEROX) of all participants were measured and the oxidative stress index (OSI) was calculated. The assessment included structured measurements, including the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS). Results

Introduction: Genetic factors may influence response to antipsychotic treatment in patients with schizophrenia. The synaptosomal-associated protein of 25 kDa (SNAP-25) gene may be an interesting candidate gene regarding clinical outcome with antipsychotics. SNAP-25 is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters (1). Muller et al. reported that Mu1I T/G, Tail T/C polymorphisms in the SNAP-25 gene were associated with both antipsychotic drug response and drug induced weight gain (3). We aimed to evaluate the association of SNAP-25 (Mn1I T/G and Ddell T/C) polymorphisms with response to olanzapine in our study. Yontem: Our study comprised 86 unrelated subjects who strictly met DSM-IV criteria for schizophrenia and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with rating scales. Results: When we compare the groups TT with TG+ GG patients with T/T genotype had better response to olanzapine for SANS scale in SNAP-25 Mn1I polymorphism. Also patients with TC+ CC genotype were responded better than patients with TT genotype for SNAP-25 Ddell polymorphism. Conclusion: Muller et al. reported that MnII and Tail polymorphisms (but not Ddel polymophism) were associated with response to olanzapine. Interestingly we found an association between SNAP-25 Ddell T/C polymorphism and response to olanzapine treatment. SNAP-25 gene polymorphisms might be related to antipsychotic response but further studies were needed.

Many drugs may cause skin reactions, but skin reactions are seen more commonly with psychotropic drugs. Dermatologic adverse effects have increased because use of antidepressant drugs have become more common all over the world. Most of these adverse effects are benign reactions but rarely serious adverse skin reactions might occur due to antidepressant drugs. There were several case reports about dermatologic side effects of antidepressants in the literature. We present two more cases of adverse skin reactions due to antidepressants; a case of erythema multiforme due to bupropion and a case of acute urticaria due to escitalopram.

Olanzapine is a second-generation antipsychotic that may cause weight gain and metabolic syndrome in some cases. The peroxisome proliferator-activated receptor (PPAR)-gamma is an important gene in the progress of type II diabetes and metabolic syndrome. In recent studies the polymorphism of the PPAR-gamma has been studied in type II diabetes mellitus, polycystic ovary syndrome, and insulin resistance syndrome. It is aimed to evaluate the association between polymorphism of PPAR-gamma gene and olanzapine-induced weight gain. Our study comprised 95 unrelated subjects who strictly met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for schizophrenia, and all were of Turkish origin. All patients were evaluated with rating scales, and genetic analyses were performed. We found statistically significant differences between pretreatment and posttreatment body mass index and weight change in Pro12Ala polymorphism of PPAR-gamma2. Our results suggest that genetic polymorphism of PPAR might be important in olanzapine-induced weight gain and that genetic variance of people might be considered in antipsychotic medication selection.

P-glycoprotein (P-gp), an efflux transporter protein, is an ABC transporter encoded by the multidrug resistance 1 gene (MDR1, ABCB1). The common synonymous C3435T polymorphism in exon 26 is reported to associate with lower P-gp functional expression and drug uptake. Many extended pharmacogenomics, functional, and complex disease association studies focused mainly on this polymorphism. We investigated the association of exon 26 C3435T genetic variants of MDR1 gene with susceptibility to bipolar disorder and serum valproic acid concentration. Totally, 104 patients meeting DSM-IV criteria for bipolar disorder and 169 controls were admitted to the study. There was statistically significant difference between the genotypes of bipolar patients (CT 91.2%, TT 6.8%, and CC 2%) and controls (CT 52.7%, TT 26%, CC 21.3%) although their allelic distribution was similar. The serum valproic acid concentrations of the patients with CT, TT and CC genotypes were 72.92 +/- A 20.55, 80.47 +/- A 14.01 and 68.29 +/- A 12.17 mu g/ml, respectively, and there was no significant difference between the C3435T genotypes.

Maintenance electroconvulsive therapy is used for refractory bipolar disorder. We present a middle-aged man with refractory bipolar disorder who was successfully treated with maintenance electroconvulsive therapy and long-acting risperidone.

Antipsychotic-induced noticeable weight gain and metabolic syndrome cause serious health problems in psychiatric patients with the foremost of diabetes. The nature of medication-induced weight gain is not the same for everyone, besides varying with the medication and person, most frequently it is observed in people using atypical antipsychotics. Mostly Foremost genetic, but also other studies researching to predict what rate of weight gain in which patients have been going on. With the aim of guiding future genetic studies exploring the genetics of weight gain the previous studies conducted on this topic were reviewed in this study.

Olanzapine is a second-generation antipsychotic that may cause weight gain and metabolic syndrome in some cases. The peroxisome proliferator-activated receptor (PPAR)-gamma is an important gene in the progress of type II diabetes and metabolic syndrome. In recent studies the polymorphism of the PPAR-gamma has been studied in type II diabetes mellitus, polycystic ovary syndrome, and insulin resistance syndrome. It is aimed to evaluate the association between polymorphism of PPAR-gamma gene and olanzapine-induced weight gain. Our study comprised 95 unrelated subjects who strictly met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for schizophrenia, and all were of Turkish origin. All patients were evaluated with rating scales, and genetic analyses were performed. We found statistically significant differences between pretreatment and posttreatment body mass index and weight change in Pro12Ala polymorphism of PPAR-gamma 2. Our results suggest that genetic polymorphism of PPAR might be important in olanzapine-induced weight gain and that genetic variance of people might be considered in antipsychotic medication selection.

Introduction: The synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters (1). Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD) (2). We investigated whether these SNAP-25 polymorphisms (Mn1I T/G and Ddell T/C) were also associated with ADHD in the Turkish population. Method: Our study comprised unrelated 79 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah and Turgay rating scales. Results: SNAP-25 Ddell polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 Mn1I polymorphism (p