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Background Nitric oxide (NO) is an endogenous substance which has several endocrine functions and may act as neurotransmitter in the brain. High levels of NO may provoke nitrosative stress. Aim It was aimed to examine serum levels of NO in patients with depressive episodes who were treated with electroconvulsive therapy (ECT) in this study. Methods The design was a case-control, follow-up study. Patients with depressive episodes (n = 23) and a healthy control group (n = 21) were enrolled. Three serum samples were obtained from the patient group (before ECT, after first and seventh sessions). NO, nitrite, and nitrate levels were examined. Statistical analysis Differences between groups were examined with t-test or Mann-Whitney U-test. Longitudinal data were evaluated with Panel Regression Analysis and Kruskal-Wallis Test. Results Serum levels of NO and nitrite decreased significantly after the seventh session of ECT administration compared to the baseline and first session. Nitrate levels did not differ between the assessments. Conclusions Reduction of the serum NO and nitrite levels might be a contributing factor for hypertension during the sessions. These findings are reflect the circulating NO levels. Further studies may dissect NO physiology in the brain in mental disorders and potential external effects.

Objective In the current study, we aimed to investigate fasting plasma levels of glucose, insulin, growth hormone, IGF-1, and lipid profile in remission schizophrenia patients, treatment resistant schizophrenia patients and healthy controls and to determine whether IGF-1 levels can be used as a theranostic biomarker in schizophrenia. Methods Sixty-two patients under remission from schizophrenia, sixty-five treatment-resistant patients with schizophrenia and sixty-two healthy controls were included in the study. All patients were recruited and evaluated over 11 months. Symptoms at the time of evaluation were assessed twice using BPRS, PANSS, CGI, and GAF scales by an experienced psychiatrist in accordance with Andreaseen's remission criteria and TRIPS group resistance criteria. Blood samples were collected from all participants to determine fasting glucose, LDL, HDL, Triglyceride, Total Cholesterol, fasting, insulin, GH and IGF-1 levels. Results Fasting blood glucose levels were found to be higher in patients with schizophrenia than in healthy controls. Moreover, LDL levels of the treatment sensitive group were higher than that of the treatment resistant group while they were not significantly different from the healthy controls. IGF-1 levels were lower in the treatment sensitive group than in both treatment resistant and healthy control groups. IGF-1, LDL and age of disease onset were found to be significantly associated with treatment resistance in a regression model. Discussion In the present study, remitted patients with schizophrenia could be distinguished from treatment-resistant patients and healthy controls with serum IGF-1, fasting glucose and LDL levels. In addition, we found that smoking and age of disease onset together with IGF-1 levels could significantly predict resistance to treatment.

OBJECTIVE: The aim of the study was to investigate the relationship between behavioural and psychological symptoms of Alzheimer’s disease with caregiver burden and depression. METHODS: In this prospective and clinic-based study, 71 patients over 65 years of age diagnosed with Alzheimer's disease according to DSM IV diagnostic criteria who were admitted to Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery between April 2014 and November 2014 and their 71 care givers were included in the study. Information on patients and caregivers were assessed using the sociodemographic and clinical data form. The Standardized Mini Mental State Examination (SMMSE) and the Global Deterioration Scale (GDS) were used to determine disease severity and stage. The Neuropsychiatric Inventory (NPI) was used to assess the behavioural and psychological symptoms of the patients. Caregivers’ burden and depression were assessed using the Zarit Caregiver Burden Scale (ZCBS) and the Hamilton Depression Rating Scale (HAM-D). SPSS 22.0 program was used for the statistical analysis of data. RESULTS: The average age of the caregivers was 52, 81.7% (n: 58) were female and 53.5% (n: 38) were the patients’ daughters. Caregiver burden was found to be mild in 50.7% (n: 36), moderate in 15.5% (n: 11) and heavy in 33.8% (n: 24) of caregivers. Depression was found to be mild in 19.7% (n: 14), moderate in 19.7% (n: 14) and severe in 4.2% (n: 3) of caregivers. The most common behavioural and psychological symptoms were; apathy (60.6%), delusions (57.7%), depression / dysphoria (56.3%), hallucinations (53.5%), irritability (47.9%), anxiety (32.4%), abnormal motor behaviour (29.6%), agitation / aggression (26.8%), eating-appetite changes (26.8%) and elation / euphoria (1.4%). Patient caregivers in the group with more behavioural and psychological symptoms had more caregiving burden and depression. Symptoms having a significant effect on caregiver burden were delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, apathy, disinhibition, irritability, abnormal motor behaviour. Behavioural and psychological symptoms that correlate with caregiver depression are agitation/aggression, anxiety, disinhibition, irritability. In the correlation analysis between NPE and ZCBS factor groups, only the factor 4 showing the economic burden did not show any significant correlation. CONCLUSION: Results show that behavioural and psychological symptoms in Alzheimer’s patients increase the caregiver burden and cause caregiver depression. Preventive measures to prevent the emergence of such symptoms and effective ad rapid intervention are required. Further multi-center studies with a prospective design, involving different cultures, patients from a wider population, different care settings are required.

10th International Congress on Psychopharmacology & 6th International Symposium on Child and Adolescent Psychopharmacology[Abstract:0110] [Addiction]Cessation of cigarette smoking in adolescents: s...

WOS: 000452309400002, OBJECTIVE: The aim of the study was to examine the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic (AP) medication on symptom profile in patients with a diagnosis of schizophrenia who had received acute psychiatric inpatient treatment. METHODS: In this prospective study, patients were evaluated for inclusion in the study who were diagnosed with schizophrenia according to DSM-IV diagnostic criteria and were to receive ECT. The patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression - Improvement (CGI-I) sub-scale before the first session ECT, once following every two subsequent sessions and after the final session. RESULTS: The patients showed significant improvements in BPRS scores at each evaluation compared with their scores at baseline, and a significant clinical improvement was found on the CGI-I sub-scale at the end of treatment. Across all SAPS sub-scores, significant decreases were found, and the symptoms related to hallucinations and positive formal thought disorder showed the most rapid response to treatment. Across all SANS sub-scores, significant decreases were found, and affective flattening or blunting symptoms responded most rapidly to treatment. CONCLUSION: One of the most important findings in the present study of hospitalized patients with acute schizophrenia was the good response to treatment, which provided significant improvements in both positive and negative symptoms. The most rapid response to treatment was found for hallucinations, positive formal thought disorder, and affective flattening or blunting symptoms. The most important limitation of our study may be the small number of cases. In future, well-standardized studies using a double-blinded, comparative, prospective design and including a sufficient number of patients are needed.

The purpose of this study was to explore further whether depression is associated with problematic eating behaviors in a sample of Turkish bariatric surgery candidates. This descriptive study included 168 consecutively seen bariatric surgery candidates in a university bariatric surgery outpatient. Participants were asked to complete the Dutch Eating Behavior Questionnaire (DEBQ), the Beck Depression Inventory (BDI) and surveys assessing sociodemographic and clinical variables. Correlations and linear regression analyses were performed to evaluate the relationship between clinical and demographic variables. Participants had a mean age 37.7 ± 11.3 years and BMI of 46.4 ± 6.7 kg/m2 (SD = 6.7). According to BDI scores, 75.5 % of the patients had mild, moderate, or severe depressive symptomatology. Lower levels of depressive symptoms were associated with higher levels of restrictive eating (r = −0.17; p = 0.04), whereas higher levels of depressive symptoms were associated with more frequent eating in response to both internal (r = 0.3; p = 0.002) and external (r = 0.2; p = 0.04) cues. The BDI scores were significantly associated with increased external eating (s = 0.03, p 0.1) was not associated with DEBQ total scores. This research suggests that mild, moderate or severe depressive symptoms are observed in most of the bariatric surgical candidate patients. There is a positive correlation between severity of depression and emotional/external eating behaviors, and a negative correlation between severity of depression and restrictive eating behavior. Additional research is needed to determine whether treating depression preoperatively can assist with alleviating problematic eating behaviors.

Objectives: Depressive disorders are characterized by oxidative stress and burden of oxidative stress may provoke cellular and biochemical challenges. Thiols are converted into non-reactive disulphides after reacting with oxygen radicals and converted back to thiols. N-terminus of the albumin can be modified by biochemical strain and modified albumin is called ischemia modified albumin (IMA). In this study, it was aimed to assess potential effects of electroconvulsive therapy (ECT) on thiol disulphide homeostasis and IMA levels in depression. Methods: Twenty-three patients with depressive episodes (major depressive disorder n=16), and (bipolar disorder n=7) and 21 healthy controls were enrolled. Serum samples were collected at three time points: one day before ECT, one hour after the first ECT session and one hour after the last session (remission). Thiol disulphide homeostasis and IMA levels were measured. Results: Total thiol levels were significantly (p=0.032), native thiol levels were trend level (p=0.056) depleted in patients with depression in comparison to that of the healthy control group. Disulphide levels did not differ between the groups. IMA levels were higher (p

Objective: The aim of this study is to investigate if the nocturnal panic attack has different features and might be considered as a subtype or not. Methods: Sociodemographic data form, SCID-I, SCID-II, Panic and Agoraphobia Scale (PAS), Hamilton Depression Scale (HAM-D), Beck Anxiety Scale, and Bakirkoy Panic Disorder Behavioral Changes Form are applied to the participants. 51 of the 98 patients were suffering from Nocturnal Panic Attacks according to the inclusion/exclusion criteria. Results: It was revealed that 47.9% of the panic disorder patients were suffering from nocturnal panic attacks. The most frequent symptoms in nocturnal panic disorder cases were experiences of feelings like drowning, lethargy, palpitation, vertigo, fear of death, and anxiety. The existence of nocturnal panic attacks is found to be related with severity of the disorder and comorbid depression. Moreover, comorbid sleep disturbances characterized with troubles in falling asleep, difficulty in sustaining sleep, feeling tired in the morning, were observed. There were sleep related avoidances and behavioral changes. Panic disorder patients with nocturnal panic attacks were found to avoid sleeping, or going to bed alone. Conclusions: Panic disorder cases with nocturnal panic attacks had more severe symptoms. From here, it can be concluded that it might be a subtype of panic disorder.

Acquired immune deficiency syndrome (AIDS) is a neuromedical disorder associated with infection by virus of the retroviridae class known as human immunodeficiency virus (HIV) [1]. Acquired immunodeficiency syndrome (AIDS) which is a global pandemic, was first identified in 1981 and by 2009 it has led to nearly 30 million deaths. Homosexual men are the largest risk group for HIV infection and constitute about two- thirds of the reported cases in the United States. In African countries heterosexual transmission is more common. The next largest group is injection drug users. Heterosexual persons infected sexual intercourse, new-borns infected via placental transmission, and recipients of HIV-contaminated blood transfusions, including persons with haemophilia make up the rest. According to the data of Turkish Ministry of Health and Social Services in 2012 there were total of 5740 cases (Male: 4093, Female: 1635, Unknown: 12). 1024 of the cases were AIDS disease and 4716 HIV seropositive [2].The distribution of etiology during 2012 is as follows: The total number of HIV cases is 1024. Heterosexual persons infected sexual intercourse are 368 (35.9%); unknown etiology is 500 (48.8%); homosexual persons infected sexual intercourse are 136 (13.3%); new-borns infected via placental transmission are 11 (1.1%); injection drug users are 6 (0.6%); recipients of HIV-contaminated blood transfusions are 3 (0.3%). In central nervous system infection of cells primary astrocytes is responsible for neuropsychiatric manifestation. Recent medical advances have begun to alter natural progression of the illness from one of the accelerating deterioration to more chronic course. Many studies have been done to know prevalence of psychiatric morbidity in HIV positive patients and they found high psychiatric morbidity that ranged from 4-60% [3-11]. Among all psychiatric morbidity, depression is one of the most common psychiatric disorders. Depression is 2-4 times more prevalent in HIV in comparison to general population [12-15]. Discovery of the infection has a dramatic psychological impact on the patient, as does the disease relentless progression. The neurotropic of virus itself produces neuropath logical changes in deep grey structure whose dysfunction is known to cause depression. Depression often goes undiagnosed and untreated. As many as one in three persons with HIV may suffer from depression. Mario Maj (1990) [16] and Ayuso Mateo (2002) [17] also support this fact that the dramatic psychological impact of the discovery of the infection causes acute stress reaction. Mario Maj (1996) [18] reported that the possible effects of the cognitive impairment related to HIV infection of the brain (psychomotor slowing, forgetfulness and difficulties in concentration are early symptoms of this impairment) may inflate estimates of depression in HIV infected people.

Objectives This study aimed to compare the effects of propofol, thiopental, and etomidate, which are routinely used in anesthesia for electroconvulsive therapy (ECT), on the cardiovascular system, seizure variables, recovery, cognitive functions, and response to treatment. Methods Male patients hospitalized at the Seventh Psychiatry Clinics of the Bakirkoy Teaching Hospital for Psychiatry, Neurology, and Neurosurgery who were treated with ECT were investigated prospectively. The effects on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables (duration and intensity of seizure), and recovery variables were recorded at every session, on prespecified time points, and the findings of the first session were used in this evaluation. In addition, clinical responses to treatment were evaluated with tests of cognitive functions before and after a course of ECT. Adverse effects were recorded. Results The sociodemographic characteristics of the 3 treatment groups were similar. There were no significant differences among the groups in terms of effects on cardiovascular system variables, seizure variables, and cognitive functions. The clinical response to ECT was good in all groups, without any significant differences. Conclusions Propofol, etomidate, and thiopental are associated with similar safety and efficacy profiles.

Aim: Alcohol and substance use are the most common comorbidities among patients with schizophrenia, with significantly higher levels of burden reported among primary caregivers. In this study, we aimed to assess the impact of alcohol and substance use on caregivers, and the effects of the severity of disease symptoms and certain attributes of patients and their primary caregivers on the burden, depressive symptoms, quality of life, and anxiety levels of caregivers. Methods: We recruited 100 patients with schizophrenia according to DSM-IV TR from inpatient clinics of Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery and their primary caregivers from September 2010 to March 2011. The severity of patient symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). All caregivers completed the Sociodemographic and Clinical data form, The Zarit Burden Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, and WHO Quality of life-BREF. Results: The ages of caregivers and patients were 23–68 and 20–65 years, respectively. The primary caregiver was the patient’s mother in 53% of cases. We found levels of burden that were significantly higher for caregivers of patients with alcohol or substance use, and these were positively correlated with the positive psychotic subscale of PANSS. Caregivers of patients without alcohol and substance use had significantly higher scores for psychological and social relationship domains of WHOQOL-BREF. Discussion: Alcohol and substance use disorder which causing more complicated and severe needs of schizophrenia patients is associated with increased level of caregiver burden, depression and anxiety levels and decreased quality of life. Our findings suggest that there is a significant relationship between caregiver burden and alcohol and substance use by patients with schizophrenia.

Objective: Our aim is to compare demographic and clinical characteristics of patients with early and late-onset diagnosed as bipolar disorder type I (BPD-I) manic episode retrospectively. Method: A total of 24 elderly (?65 years old) hospitalized patients with bipolar disorder were divided into 2 groups as those with early-onset and late-onset disorder, according to a threshold of 50 years of age, and were retrospectively compared with 29 young patients (19-55 years old) in terms of sociodemographic characteristics, clinical symptoms, family history, prophylactic treatment, co-existing medical conditions, duration of hospitalization, psychiatric treatment, and clinical improvement. Results: A positive family history was also more prevalent in young patients and patients with early-onset disease. Co-existing medical conditions were more common in patients with late-onset disease. A positive correlation was found between the duration of education and duration of illness. Flight of ideas and pressured speech were more commonly observed in young patients and patients with early-onset disease. While delusions of erotomanic type were more frequent in young patients, persecution delusions were more common in elderly patients. In terms of treatment, valproate was preferred in the elderly patients and antipsychotic medications were more frequently used in late-onset elderly patients when compared to early-onset elderly patients. The duration of hospitalization was longer in elderly patients than younger ones. Conclusion: Our findings show that late-onset mania has different characteristics compared to early-onset mania in terms of clinical characteristics, symptom profile, family history, co-existing medical diseases, duration of hospitalization, and response to treatment. However, it is hard to conclude that it as a different clinical subgroup when previous studies about late-onset mania are taken into consideration. Further studies with adequate sample sizes are needed.