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Objective: To investigate the relationship between Expressed Emotion (EE) and working memory (WM) capacity in the caregivers of patients with psychosis, controlling for the potential confounds, namely, personality traits, subsyndromal psychotic symptoms, burden of care and the patient’s illness severity. Materials and Methods: The study covered 152 related caregivers of psychotic patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with a psychotic component. The study continued with 120 participants who met the recruitment criteria. Patients were assessed with a Structured Clinical Interview for Axis I Disorders (SCID-I), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression Scale (CGI). For related caregivers; SCID-I, Expressed Emotion Scale (EES), Temperament and Character Inventory (TCI); Magical Ideation Scale; Physical Anhedonia Scale; Social Anhedonia Scale; Zarit Caregiver Burden Scale (ZCBS), and Auditory Consonant Trigram Test (ACT) were used. A stepwise regression analysis was employed to analyze the relevant variables that had an independent impact on EES scores. Results: There was a significant negative relationship between the ACT and EES scores (r=-.25, p

BackgroundThere is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.MethodsWe analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.ResultsThe impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: −0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465).ConclusionsThe results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.

European Community's Seventh Framework Program, European Commission [HEALTH-F2-2009-241909]; Scientific and Technological Research Council of Turkey, 2219 International Postdoctoral Research Fellowship Program; Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, and PI19/024)..., Erzin, G., Pries, L.-K., van Os, J., Fusar-Poli, L., Delespaul, P., Kenis, G., Luykx, J.J., Lin, B.D., Richards, A.L., Akdede, B., Binbay, T., Altınyazar, V., Yalınçetin, B., Gümüş-Akay, G., Cihan, B., Soygür, H., Ulaş, H., Cankurtaran, E.Ş., Kaymak, S.U., Mihaljevic, M.M., Andric-Petrovic, S., Mirjanic, T., Bernardo, M., Mezquida, G., Amoretti, S., Bobes, J., Saiz, P.A., García-Portilla, M.P., Sanjuan, J., Aguilar, E.J., Santos, J.L., Jiménez-López, E., Arrojo, M., Carracedo, A., López, G., González-Peñas, J., Parellada, M., Maric, N.P., Atbaşoğlu, C., Ucok, A., Alptekin, K., Saka, M.C., Arango, C., O'Donovan, M.C., Rutten, B.P.F., Guloksuz, S., Genetic Risk and Outcome of Psychosis (GROUP) investigators

Background:Pain is one of the most frequent symptoms in older adults. It severely impairs quality of life, increases delirium risk, and may lead to progression of dementia. Assessment of pain performed by taking anamnesis from the patient is not reliable in patients with dementia due to cooperation and communication problems. The aim of this study was to assess pain and its consequences in patients with dementia.Methods:Seventy-five nursing home residents with dementia were enrolled. After comprehensive geriatric assessment, presence of pain was asked to patients, and Pain Assessment in Advanced Dementia (PAINAD), Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT), Pain Assessment for the Dementing Elderly (PADE), Wong-Baker Faces Pain Rating Scale, and Numeric Rating Scale tests were performed.Results:Mean age was 81.1 (7.0), and 46.7% (n = 35) were female. Thirty-two percent of the patients were at early stage, 24% at moderate stage, and 44% at severe stage. Although the number of patients declaring pain was lower in moderate and severe stage, scores of PADE, PAINAD, and DS-DAT were significantly higher in severe stage showing the presence of pain ( P < .001). Furthermore, scores of PADE, PAINAD, and DS-DAT were negatively correlated with comprehensive geriatric assessment test scores.Conclusion:These results demonstrate that pain is not rare in patients with dementia, but they are not usually capable of expressing it, especially in the severe stage. Therefore, objective pain assessment scales developed for patients with dementia should be routinely used and management of pain should be done regarding the association of pain with other geriatric syndromes.

The EUGEI project was supported by the European Community’s Seventh Framework Program under grant agreement No. HEALTH-F2- 2009-241909 (Project EU-GEI). Dr. Arango was supported by the Spanish Ministry of Science and Innovation; Instituto de Salud Carlos III (SAM16-PE07CP1, PI16/02012, PI19/024); CIBERSAM (...), Fusar-Poli, L; Pries, LK; van Os, J; Erzin, G; Delespaul, P; Kenis, G; Luykx, JJ; Lin, BCD; Richards, AL; Akdede, B; Binbay, T; Altinyazar, V; Yalincetin, B; Gumus-Akay, G; Cihan, B; Soygur, H; Ulas, H; Cankurtaran, ES; Kaymak, SU; Mihaljevic, MM; Andric-Petrovic, S; Mirjanic, T; Bernardo, M; Mezquida, G; Amoretti, S; Bobes, J; Saiz, PA; Garcia-Portilla, MP; Sanjuan, J; Aguilar, EJ; Santos, JL; Jimenez-Lopez, E; Arrojo, M; Carracedo, A; Lopez, G; Gonzalez-Penas, J; Parellada, M; Maric, NP; Atbasoglu, C; Ucok, A; Alptekin, K; Saka, MC; Aguglia, E; Arango, C; O'Donovan, M; Rutten, BPF; Guloksuz, S

BackgroundFirst-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.MethodsWe conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.ResultsIn both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.ConclusionsThe degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.

Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB.This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed.Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment.Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

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

Background: Gamma glutamyltransferase (GGT) plays a role in cellular glutathione uptake, which is an important element of antioxidant mechanisms. An increase in serum GGT is thought to be an early and sensitive marker of oxidative stress. Oxidative stress has a role in the pathogenesis of Alzheimer's disease (AD). The aim of this study was to investigate the GGT levels in AD.Method: In this cross-sectional study, 132 patients with AD (mean age: 74.1 ± 7.4, female 62.9%) and 158 age- and gender-matched normal controls (mean age: 74.5 ± 6.3, female 67.1%) were evaluated. For cognitive assessment, MMSE and clock drawing tests were performed; DSM-IV and NINCDS-ADRDA criteria were used. Serum GGT, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase concentrations were determined.Results: Median (min-max) GGT levels were 18 (9–70) in AD group and 17 (5–32) in normal controls. Mann-Whitney U test showed that GGT levels were significantly higher in AD patients (p = 0.012). Linear regression analysis revealed AD was an independent correlate of elevated GGT levels. Hypertension, diabetes mellitus, total cholesterol, and low density lipoprotein cholesterol were not associated with GGT levels.Conclusion: GGT levels were increased significantly in AD patients. To evaluate the role of GGT as a marker of oxidative stress in AD, further studies are needed.

Background:No specialized geriatric psychiatry consultation services are available for elderly people in the institutional care system in Turkey. Our aim was to evaluate psychiatric consultations among the residents of three homes for the elderly in a country with a rapidly aging population, and to investigate possible problems regarding psychiatric consultations.Methods:The residents of three homes for the elderly, which served partially as “care and rehabilitation centers” (equivalent to nursing homes), were chosen for the study. Data on the use of psychiatric services (mainly patient consultations with a visiting psychiatrist) were collected and analyzed.Results:The percentage of patients in the three homes for the elderly who had psychiatric consultations between 2005 and 2007 was 31.8% (172/540). The main reasons for referral were forgetfulness (61%), depressive symptoms (37.7%), agitation and disruptive behavior (29.6%), and psychotic symptoms (27.9%). Of these patients, 46.5% were diagnosed with dementia, 20.9% with depression, 20.5% with behavioral and psychotic symptoms of dementia, and 18.6 % with primary psychotic disorders such as schizophrenia.Conclusion:Homes for the elderly in Turkey are not adequate in terms of consultations for psychiatric problems. Integration of these institutions with hospitals and organizing routine consultation visits from the psychiatry units would enhance the mental health of the elderly. Supporting the staff, maintaining good cooperation between them, and organizing educational programs in the field of mental health of the elderly are also required.

The most efficient strategy for combating Alzheimer's disease (AD) is to prevent the onset of clinically significant symptoms. Determining the clinical characteristics, risk factors, and indices of cognitive reserve would help in achieving this goal. The aim of this study was to determine the risk factors for AD and vascular dementia (VD) in the elderly and to highlight the importance of risk factor modification in the early diagnosis. Consecutive 1436 patients (mean age = 72.7 ± 6.9 years, 34.2% male) were enrolled in the study. After a comprehensive geriatric and cognitive assessment, patients were grouped as AD group (n = 203), VD group (n = 73) and normal cognitive status (NCS) group (n = 1160). Thirty-three possibly related factors including demographic characteristics, co-existing diseases and laboratory parameters were examined. The results revealed that female sex, advanced age, depression, and intake of vitamin supplements were independent related factors for AD; whereas depression and low-density lipoprotein-cholesterol (LDL-C) were independent related factors for VD. For every geriatric patient admitted for any reason, cognitive assessment should be performed, risk factors should be determined and the patients at high risk should be followed up carefully.

Inflammation may play an important role in Alzheimer disease (AD) pathogenesis. A growing amount of evidence indicates that resistin has hallmark regulatory functions such as inflammatory states. The aim of this study was to determine whether plasma resistin levels would be useful in the diagnosis of patients with AD and to investigate the relationships between resistin and other inflammatory markers such as hs-CRP and TNF-α. Materials and methods: In this cross-sectional study, 38 AD patients and 32 control subjects with normal cognitive function aged 65 years and over were included. The diagnosis of AD was made according to DSM-IV and NINCDS-ADRDA criteria. Serum levels of resistin were measured with an enzyme-linked immunosorbent assay method using the human resistin E50 kit. Results: The median resistin level of AD patients was significantly higher than in the control group (86.3 vs. 70.8 pg/mL, P = 0.002). Overall accuracy of resistin in determining AD was 70.66%, with sensitivity, specificity, PPV, and NPV of 75.0%, 65.5%, 73.0%, and 67.9%, respectively. There was no statistically significant difference between AD patients and control subjects with respect to hs-CRP and TNF-α levels. Conclusion: Resistin levels may be considered as a predictor of AD and it may predict activation of the immune system in AD pathophysiology.

Background/aim: The Neuropsychiatric Inventory-Clinician (NPI-C) scale is one of the best-known scales for evaluating the behavioral and psychological symptoms of dementia. This study aimed to assess the reliability and validity of the Turkish version of the NPI-C scale in patients with Alzheimer disease (AD). Materials and methods: The NPI-C scale was administered to 125 patients with AD. For reliability, both Cronbach's α and interrater reliability were analyzed. The Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) scale was applied for validity and, in addition, the Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL) scale, and Disability Assessment of Dementia (DAD) scale were completed. Results: The Turkish version of the NPI-C scale showed high internal consistency (Cronbach's α = 0.75) and mostly good interrater reliability. Assessments of validity showed that the NPI-C and corresponding BEHAVE-AD domains were found to be significantly correlated, between 0.925 and 0.195. Moreover, the correlations between NPI-C and MMSE were significant for all domains except the dysphoria, anxiety, and elation/euphoria domains. When we conducted a correlation analysis of NPI-C with IADL, all domains were statistically significantly correlated except aggression, anxiety, elation/euphoria, and dysphoria. Conclusion: The Turkish version of the NPI-C scale was found to be a reliable and valid instrument to assess neuropsychiatric symptoms in Turkish elderly subjects with AD.

Background/aim: To compare plasma vitamin D concentrations among patients with normal cognitive function (control group), mild cognitive impairment (MCI), and Alzheimer disease (AD). Materials and methods: In total, 158 patients with AD, 228 patients with MCI, and 603 control subjects were included. Plasma levels of 25-hydroxyvitamin D were measured after comprehensive geriatric assessment and compared among groups. SPSS 15.0 was used for statistical analysis. Results: Mean levels of 25-hydroxyvitamin D were significantly different among the 3 groups of AD patients, MCI patients, and controls (P < 0.001). Post hoc analysis revealed that the levels were significantly lower in the MCI group than the control group (P = 0.002) and significantly lower in the AD group than the control group (P = 0.003). Multivariate analysis showed that age (OR: 1.070, 95% CI: 1.025-1.116, P = 0.002), instrumental activities of daily living score (OR: 0.920, 95% CI: 0.850-0.995, P = 0.037), 25-hydroxyvitamin D level (OR: 0.959, 95% CI: 0.932-0.987, P = 0.004), and diabetes mellitus (OR: 2.476, 95% CI: 1.153-5.319, P = 0.020) were factors independently associated with AD. Conclusion: This study demonstrated that there is a correlation between plasma 25-hydroxyvitamin D levels and cognitive functions.

Turkey is a country where a young population is dominant. However, 6 percent of the population was older than 65 in 2005, approximately 4-5 million people. The percentage of the elderly is expected to double by 2020. Along with this expectation, geriatric psychiatry is a rapidly developing area in Turkey. In this paper, the political approaches of the Turkish government to the elderly population and their mental health, the advantages and limitations related to aging are discussed in detail from a developing country perspective.

OBJECTIVES: To compare endothelial function of people with Alzheimer's disease (AD) with that of people without. DESIGN: Case-control study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment. MEASUREMENTS: Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery. RESULTS: Mean age ± standard deviation was 78 ± 5.9 in the group with AD (11 female and 14 male) and 72.1 ± 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0–7) than controls (median 8.41, range 1–14) (P < .001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=−0.603, P < .001). CONCLUSION: Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.

The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for identifying clinically significant distress. One hundred and eighty two cancer patients completed the DT, Problem List (PL), and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). The receiver operating characteristic (ROC) curve analyses of DT scores yielded an estimated area under the curve of 0.66 when compared to the HADS cut-off score, suggesting the DT is an effective scale to discriminate between classified cancer patients both with and without clinically significant distress. The DT cut-off score of 4 yielded the optimal combination of sensitivity and specificity. Scores on the DT were moderately correlated to the HADS (p

Depression is an important but inadequately diagnosed mood disorder in elderly. Depressed elderly patients often have chronic concomitant diseases. This paper intended to determine the prevalence of depression and its relation with concomitant disorders and social status among the patients admitted to our geriatric unit. Seven hundred and eighty-nine females and 466 males admitted to our unit were examined for the presence of depression by using the geriatric depression scale (GDS) test. The presence of concomitant diseases was assessed. Depression was diagnosed in 273 patients (21.8%), 193 (70.7%) females and 80 (29.3%) males. Depressed patients suffered from a wide range of other diseases the number and prevalence of which were as follows: Alzheimer's disease (AD) (34; 12.5%), vascular dementia (27; 9.9%), hypertension (HT) (211; 77.3%), diabetes mellitus (DM) (64; 23.4%), osteoporosis (182; 66.7%), atherosclerotic coronary artery disease (CAD) (89; 32.6%), cardiac failure (23; 8.5%), bronchial asthma (8; 2.9%), chronic obstructive pulmonary disease (COPD) (25; 9.2%) and osteoarthritis (133; 48.8%). The correlation between depression and concomitant diseases was statistically significant in hypertensive, demented and osteoporotic patients, as determined in a large elderly population. Previous studies examined the correlation of depression with only one concomitant disease, while we performed the analysis on multiple correlations.

This study aimed to determine the reliability and validity of the Turkish version of Disability Assessment for Dementia (DAD) scale in the Turkish elderly population with Alzheimer disease (AD). The DAD scale was administered to the primary caregivers of 157 patients (age 77.7 ± 6.8 years) with AD. The Turkish version of the DAD scale showed high internal consistency (Cronbach α = .942), excellent test–retest, and interrater reliability (intraclass correlation coefficient [ICC] = 0.996 and ICC = 0.994, respectively). The DAD scale was significantly correlated with activities of daily living (ADL; Modified Older Americans Research Survey ADL) and instrumental activities of daily living (IADL; Lawton and Brody IADL) scales ( r = .89, P < .001 and r = .90, P < .001). Disability Assessment for Dementia had a high negative correlation with the Global Deterioration Scale (GDS; r = −.880, P < .001). Post hoc comparisons with Tukey test showed significant differences in the mean DAD scores in different GDS stages. Construct validity was estimated using total score correlation analyses between the standardized Mini-Mental State Examination (MMSE) and the DAD scale. Results revealed high and significant correlation between MMSE score and DAD scale ( r = .812, P < .001). The results of multivariate analysis showed that DAD score was not correlated with gender, education, and age. The DAD total score was affected mostly by GDS, MMSE, and duration of the disease. Turkish version of the DAD scale was found to be a reliable and valid instrument to assess functional disability in Turkish elderly patients with AD. This scale assists caregivers and physicians to decide for proper interventions.

It is not scarce that patients experience various extrapyramidal symptoms (EPS) during antidepressant drug therapy. Thus, choice of an antidepressant drug in case of extrapyramidal side effects, at present, is a dilemma. Escitalopram, which is a recently marketed selective serotonin reuptake inhibitors (SSRI), has no such reputation. There is just one case reported for tianeptine that induced abnormal involuntary movements/extrapyramidal side effects. We would like to present a case that was successfully managed with bupropion which had developed EPS during 2 different SSRI (sertraline and escitalopram) and tianeptine therapy.

and .52 (p < .001), meaning patient’s dementia related factors were more likely to impose heavier burden on caregivers. Number of disease, perceived health status, co-residence, caregiving hours, and contact frequency were identified as factors that increased the burden score significantly. Presence of secondary caregiver and involvement in economic activity lowered caregiver burden scores significantly.Conclusions: The results of this study emphasize the importance of appropriate intervention to support family caregivers that enables caregivers to provide home based care. The cognitive, behavioral, and functional deterioration of patients is highly associated with caregiver burden. Future study is needed to understand the different difficulties in accordance with stage and type of dementia to develop the individualized interventions for family caregivers.

Increasing evidence supports the theory that oxidative stress plays an important role in the pathogenesis of Alzheimer's disease (AD). Homocysteine (Hcy), uric acid (UA), bilirubin, and albumin are simple laboratory parameters that are related to oxidative stress. In this study we compared serum Hcy and antioxidant levels in patients with AD and normal cognitive function. In this cross-sectional study, 143 AD patients and 1,553 patients with normal cognitive function aged 65 years and over were enrolled. Mean values of UA and albumin levels of AD patients were significantly lower than normal cognitive function subjects (p: 0.003 versus p < 0.001, respectively). Mean value of Hcy levels of AD patients was significantly higher than normal cognitive function subjects (p = 0.031). Multivariate regression analysis revealed that Mini-nutritional assessment short form (OR: 0.905, 95% CI: 0.850-0.965, p = 0.002), hypertension (OR: 1.573, 95% CI: 1.148-2.155, p = 0.005), UA (OR: 0.879, 95% CI: 0.788-0.981, p = 0.021), Hcy (OR: 1.040, 95% CI: 1.022-1.059, p < 0.001), and albumin (OR: 0.505, 95% CI: 0.339-0.753, p < 0.001) were independent variables predicting the occurrence of AD. Our study supports the hypothesis that a decrease in antioxidants and an increase in oxidative damage are linked to AD.

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

Evidence regarding the vascular basis of Alzheimer’s disease (AD) is growing. In vascular damage thrombomodulin tears of the cell wall and its level increases in the plasma. von Willebrand factor (vWF) is also thought to be a biomarker for vascular damage. The aim of this study was to examine the levels of vWF and thrombomodulin in AD as possible markers for vascular damage and to test their utility as an early biomarker in AD. Case-control study. Geriatric medicine outpatient clinic of a university hospital. Twenty Alzheimer’s disease patients free from vascular risk factors and 20 controls were enrolled in the study. Thrombomodulin and VWF levels of 20 AD patients and 20 controls were analyzed by commercial kits. Thrombomodulin levels were not different between Alzheimer’s disease and control groups [median (range) = 4.25 (2.27–37.00) ng/ml in Alzheimer’s disease and 3.55 (2.27–14.00) in control group, p=0.15]. Von Willebrand Factor antigen (%) levels were 188.5 (96–306) in Alzheimer’s disease, and 181 (112–284) in control group (p=0.74). Although vascular damage is thought to play role in the pathogenesis of AD, vWF and thrombomodulin failed to demonstrate the vascular damage in AD. Their utility to be used as early biomarkers of AD could not be shown.

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

This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms.Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit.There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients.Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.

To compare endothelial function of people with Alzheimer's disease (AD) with that of people without.Case-control study.Geriatric medicine outpatient clinic of a university hospital.Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment.Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery.Mean age +/- standard deviation was 78 +/- 5.9 in the group with AD (11 female and 14 male) and 72.1 +/- 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0-7) than controls (median 8.41, range 1-14) (P.001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=-0.603, P.001).Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.

An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major depression exhibit plasma interleukin-6 abnormalities and dexamethasone suppression test results. Four groups, each consisting of 30 women (1--healthy women, 2--patients with major depression, 3--breast cancer patients without major depression, 4--breast cancer patients with major depression), were compared to each other. Psychiatric evaluations were made by structured clinical interview for DSM-IV. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. A dexamethasone suppression test was applied. Breast cancer patients with major depression had markedly higher plasma levels of interleukin-6 than the other group. All breast cancer patients with depression had abnormal dexamethasone suppression test results. These findings suggest a hypothalamo-pituitary-adrenal axis activation and plasma levels of interleukin-6 and plasma interleukin-6 elevation and plasma levels if interleukin-6 and plasma levels of post cortisol concentrations. Evidence for a casual link or association of major depression with immune and endocrinological activation needs to be investigated further.

We described a 32-year-old woman with Huntington's disease (HD) who presented with severe chorea, psychosis and cognitive abnormalities. We started risperidone at 2 mg p.o./d and increased to 4 mg p.o./d after six weeks. Psychotic and motor symptoms were markedly improved. Since there was no change in cognitive functions, we added memantine at 5 mg p.o./d and gradually increased the dose to 20 mg p.o/d after five weeks. We continued risperidone and memantine for nearly six months. The patient did not show any progression of cognitive symptoms or motor abnormalities. We did not observe any psychotic symptoms.

Background: The aim of this study is to compare the results of magnetic resonance (MR) imaging, particularly the decline in hippocampal volume, of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy age-matched controls, to examine the reliability of hippocampal volumetry in the early diagnosis of AD and the correlation of the severity of hippocampal atrophy with the severity of cognitive decline.Methods: Twenty-six AD, 22 MCI and 15 normal cognitive status (NCS) patients were scanned with a 3 Tesla MR scanner. Hippocampus volumes were detected manually by Osiris 4.18.Results: Multivariate regression analysis, which was performed to adjust the covariate effects of education, age, gender, hypertension and diabetes mellitus, showed that hippocampal atrophy was correlated with AD and MCI for right hippocampus; AD, MCI and age for left hippocampus independent of other parameters. A second regression analysis revealed that MMSE was correlated with hippocampal volume.Conclusions: Hippocampal volumetry can be used in early diagnosis of cognitive impairment, as well as grading cognitive decline.

Although hyperlipidemia is known to contribute to vascular disease and it may play a role in dementia, specific studies for elderly are limited. The aim of this study is to examine the relationship between dyslipidemia and dementia. In this study, 1251 patients admitted to the Hacettepe University Division of Geriatric Medicine were enrolled. On the basis of the mini mental state examination (MMSE), the clock drawing test (CDT) scores, the APA DSM-IV and the NINCDS-ADRDA criteria and the Hachinski ischemic score (HIS), the subjects were divided into four groups: Alzheimer's disease (AD), vascular dementia (VD), mild cognitive impairment (MCI) and normal cognitive status (NCS). The lipoprotein levels were measured, and we analyzed the data using χ2 and the one-way analysis of variance methods. Among the subjects, 14.8% had low high-density lipoproteins (HDL), 58.5% had high triglyceride (TG), 73.6% had high low-density lipoproteins (LDL), and 21.6% had high lipoprotein-a (Lp(a)) of our study population. There was no difference between the dementia subgroups and the NCS group in the lipoprotein levels. The only significant relationship was between high TG levels and the AD, as well as the MCI groups. Low HDL and high LDL are important problems in elderly. Although serum lipid levels, especially of Lp(a), has recently been thought to be related with dementia, our study suggests the absence of such a relationship. The national data regarding the elderly population should be evaluated on the basis of genetic and environmental factors in each country. The present study showing no significant relationship between Lp(a) and the cognitive status adds new information to the available literature.

P604 Effect of cholinesterase inhibitors on the long-term course of cognition in patients with Alzheimer’s disease treated in a ‘real-life’ clinical setting: Results from The Frisian Alzheimer’s Disease Cohort Study E. Droogsma , M. Diekhuis , N. Veeger , P. van Walderveen , E. Huinink , C. van der Hooft , D. van Asselt Department of Geriatric Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

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

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